Healthcare Provider Details

I. General information

NPI: 1649457268
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 410
EUGENE OR
97401-8158
US

IV. Provider business mailing address

PO BOX 53
EUGENE OR
97440-0053
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-7134
  • Fax: 541-687-7135
Mailing address:
  • Phone: 541-687-7134
  • Fax: 541-687-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier165704
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier7107642
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: MR. BURT LOESSBERG
Title or Position: MANAGING PARTNER
Credential:
Phone: 541-687-7134