Healthcare Provider Details

I. General information

NPI: 1417135880
Provider Name (Legal Business Name): EAST LINN MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N SANTIAM HIGHWAY
LEBANON OR
97355-4363
US

IV. Provider business mailing address

815 NW 9TH STREET
CORVALLIS OR
97330-6173
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-6950
  • Fax: 541-451-6951
Mailing address:
  • Phone: 541-768-6768
  • Fax: 541-768-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BECKY A. PAPE
Title or Position: CEO
Credential:
Phone: 541-768-5009