Basic Information
| Provider Information | |||||||||
| NPI: | 1942475249 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 53 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974400053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416877135 | ||||||||
| FaxNumber: | 5413877135 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 N 16TH ST | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417264959 | ||||||||
| FaxNumber: | 5417412188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2008 | ||||||||
| LastUpdateDate: | 04/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | LOESSBERG | ||||||||
| AuthorizedOfficialFirstName: | BURT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5416877134 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 165704 | 05 | OR | MEDICAID | 7107642 | 05 | WA | MEDICAID |