Healthcare Provider Details

I. General information

NPI: 1558449504
Provider Name (Legal Business Name): MEDICAL IMAGING GROUP OF HILLSBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SE 8TH AVE
HILLSBORO OR
97123-4246
US

IV. Provider business mailing address

PO BOX 28130
PORTLAND OR
97228-8130
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-1000
  • Fax: 503-681-1796
Mailing address:
  • Phone: 503-681-1000
  • Fax: 503-681-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number0666431 7
License Number StateOR

VIII. Authorized Official

Name: MR. LAWRENCE HORNICK
Title or Position: SENIOR PARTNER
Credential: M.D.
Phone: 503-681-1106