MEDICARE: OPEN ADVANCED MRI OF PORTLAND, 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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1861447450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN ADVANCED MRI OF PORTLAND, LLC

Provider Business Mailing Address
First Line	:	DEPARTMENT 4888
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-4888
Country	:	US
Telephone Number	:	503-657-8663
Fax Number	:	503-723-3180

Provider Business Practice Location Address
First Line	:	9370 SW GREENBURG RD
Second Line	:	#J
City	:	PORTLAND
State	:	OR
Zip	:	97223-5442
Country	:	US
Telephone Number	:	503-246-6666
Fax Number	:	503-246-9465

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	LEVENT ADAM
Credential	:
Telephone Number	:	503-407-4697

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	12/27/2010

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