Healthcare Provider Details

I. General information

NPI: 1477505501
Provider Name (Legal Business Name): MCMINNVILLE IMAGING ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SE STRATUS AVE
MCMINNVILLE OR
97128-6255
US

IV. Provider business mailing address

PO BOX 516
CORVALLIS OR
97339-0516
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-1104
  • Fax:
Mailing address:
  • Phone: 541-758-5047
  • Fax: 541-758-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number09360
License Number StateOR

VIII. Authorized Official

Name: STEVEN H EDELMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 503-472-6620