Healthcare Provider Details

I. General information

NPI: 1033211867
Provider Name (Legal Business Name): MEDFORD OPEN IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 PROGRESS DR SUITE 101
MEDFORD OR
97504-4994
US

IV. Provider business mailing address

205 LIBERTY ST NE SUITE B
SALEM OR
97301-3586
US

V. Phone/Fax

Practice location:
  • Phone: 541-857-8563
  • Fax:
Mailing address:
  • Phone: 503-586-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateOR

VIII. Authorized Official

Name: MICHAEL D FREEMAN
Title or Position: OWNER
Credential: PHD DC MPH
Phone: 503-586-0153