Healthcare Provider Details

I. General information

NPI: 1669037982
Provider Name (Legal Business Name): SAFE HARBOR MEDICAL INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 NW SLERET AVE
GRESHAM OR
97030-5504
US

IV. Provider business mailing address

1026 NW SLERET AVE
GRESHAM OR
97030-5504
US

V. Phone/Fax

Practice location:
  • Phone: 503-776-0868
  • Fax: 855-940-1880
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SIEGFRIED BERTHELSDORF
Title or Position: DIRECTOR
Credential:
Phone: 503-776-0868