1356809073 NPI number — MEDFORD RADIOLOGICAL GROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356809073 NPI number — MEDFORD RADIOLOGICAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDFORD RADIOLOGICAL GROUP, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356809073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
842 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504-7134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-618-5800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1910 E BARNETT RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-8672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-618-5801
Provider Business Practice Location Address Fax Number:
541-982-4780
Provider Enumeration Date:
03/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PASTRANO
Authorized Official First Name:
JOE
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
RADIOLOGIST
Authorized Official Telephone Number:
541-618-5800

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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