Healthcare Provider Details

I. General information

NPI: 1720018393
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HARLOW RD
SPRINGFIELD OR
97477-1340
US

IV. Provider business mailing address

PO BOX 53
EUGENE OR
97440-0053
US

V. Phone/Fax

Practice location:
  • Phone: 541-681-8586
  • Fax: 775-624-9774
Mailing address:
  • Phone: 541-687-7134
  • Fax: 775-624-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEPHAN THIEDE
Title or Position: PRESIDENT
Credential: MD
Phone: 541-681-8586