Healthcare Provider Details

I. General information

NPI: 1104875053
Provider Name (Legal Business Name): MOUNTAINVIEW MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 SE STARK ST SUITE 180
GRESHAM OR
97030-3373
US

IV. Provider business mailing address

24076 SE STARK ST SUITE 180
GRESHAM OR
97030-3373
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-6500
  • Fax: 503-661-6005
Mailing address:
  • Phone: 503-661-6500
  • Fax: 503-661-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DARCY E. ORIN
Title or Position: MANAGING MEMBER
Credential:
Phone: 503-661-6500