Healthcare Provider Details

I. General information

NPI: 1275505448
Provider Name (Legal Business Name): CENTER FOR MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 NE CORNELL RD STE 100
HILLSBORO OR
97124-9219
US

IV. Provider business mailing address

PO BOX 25278
PORTLAND OR
97298-0278
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-8400
  • Fax: 503-216-8410
Mailing address:
  • Phone: 503-292-9108
  • Fax: 503-292-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: JAMES V HAZARD
Title or Position: MD
Credential:
Phone: 503-292-9108