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General NPI Number Information
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NPI Number | 1083590533
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Entity Type | Organization
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Legal Business Name | ELITE INTERVENTIONAL RADIOLOGY CONSULTANTS OF OREGON PC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 600 NW 11TH ST STE E10
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City | HERMISTON
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State | OR
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Zip | 97838-8602
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Country | US
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Telephone | 541-667-3825
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Fax |
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Provider Business Mailing Address
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Address Line | 12421 SW SHERI AVE
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City | LAKE SUZY
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State | FL
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Zip | 34269-5938
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | JACLYN EVANS
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Credential |
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Telephone | 727-480-2734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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