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NPI Code Detail

MEDICARE: OREGON ADVANCED IMAGING, LLC

MEDICARE: OREGON ADVANCED IMAGING, 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
12471M1202XMagnetic Resonance Imaging Radiologic Technologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831358860
Entity Type Code : Organization
Provider Name (Legal Business Name) : OREGON ADVANCED IMAGING, LLC
Provider Business Mailing Address
First Line : PO BOX 1527
Second Line :
City : MEDFORD
State : OR
Zip : 97501-0114
Country : US
Telephone Number : 541-773-8661
Fax Number : 541-842-9206
Provider Business Practice Location Address
First Line : 1107 CRATER LAKE AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97504-6241
Country : US
Telephone Number : 541-773-8661
Fax Number : 541-842-9206
Authorized Official
Title or Position : BOOKKEEPER
Name : MRS. LYNETTE KAY GUNDLACH
Credential :
Telephone Number : 541-608-8791
Provider Enumeration Date : 06/05/2008
Last Update Date : 03/31/2011

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Directions to “OREGON ADVANCED IMAGING, LLC ” Practice Location

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