Healthcare Provider Details

I. General information

NPI: 1023050457
Provider Name (Legal Business Name): RADIOLOGY CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/21/2022
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N GANTENBEIN AVE
PORTLAND OR
97227-1623
US

IV. Provider business mailing address

PO BOX 10768
PORTLAND OR
97296-0768
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-2400
  • Fax: 503-227-0218
Mailing address:
  • Phone: 503-227-2400
  • Fax: 503-227-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES GILMORE
Title or Position: PRESIDENT
Credential: MD
Phone: 503-575-2521