Basic Information
| Provider Information | |||||||||
| NPI: | 1275505448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR MEDICAL IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25278 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972980278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032929108 | ||||||||
| FaxNumber: | 5032920346 | ||||||||
| Practice Location | |||||||||
| Address1: | 10810 NE CORNELL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971249219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032168400 | ||||||||
| FaxNumber: | 5032168410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | HAZARD | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 5032929108 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 2085R0202X | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 269831 | 05 | OR | MEDICAID | DD7153 | 01 | OR | RAILROAD MEDICARE PIN | OTHER |