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General NPI Number Information
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NPI Number | 1801232483
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Entity Type | Organization
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Legal Business Name | OPEN ADVANCED MRI OF GRESHAM PS
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 1026 NW SLERET AVE
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City | GRESHAM
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State | OR
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Zip | 97030-5504
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Country | US
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Telephone | 503-246-6666
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Fax | 503-246-9465
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Provider Business Mailing Address
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Address Line | 9370 SW GREENBURG RD STE J
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City | PORTLAND
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State | OR
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Zip | 97223-5408
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Country | US
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Telephone | 503-246-6666
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Fax | 503-246-9465
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. SHAUN USHER
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Credential |
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Telephone | 503-246-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | MD00038333
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License Number State | WA
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