MEDICARE: BEND MRI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist

General Provider Information

NPI Number	:	1104167469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEND MRI LLC

Provider Business Mailing Address
First Line	:	2421 NE DOCTORS DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6031
Country	:	US
Telephone Number	:	541-388-3311
Fax Number	:	541-389-1887

Provider Business Practice Location Address
First Line	:	2421 NE DOCTORS DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6031
Country	:	US
Telephone Number	:	541-388-3311
Fax Number	:	541-389-1887

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHEN PAUL IRELAND
Credential	:	MD
Telephone Number	:	541-388-3311

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/12/2013

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