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General NPI Number Information
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NPI Number | 1770530560
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Entity Type | Organization
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Legal Business Name | OPEN ADVANCED MRI OF VANCOUVER, LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 221G NE 104TH AVE #106
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City | VANCOUVER
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State | WA
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Zip | 98664-4587
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Country | US
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Telephone | 360-253-2525
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Fax | 360-253-3611
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Provider Business Mailing Address
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Address Line | DEPARTMENT 4888
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City | CAROL STREAM
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State | IL
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Zip | 60122-4888
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Country | US
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Telephone | 503-657-8663
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Fax | 503-723-3180
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | LEVENT ADAM
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Credential |
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Telephone | 703-970-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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