1801232483 NPI number — OPEN ADVANCED MRI OF GRESHAM PS

Table of content: (NPI 1801232483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801232483 NPI number — OPEN ADVANCED MRI OF GRESHAM PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN ADVANCED MRI OF GRESHAM PS
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:
PERMANENTLY CLOSED
Provider Other Organization Name Type Code:
3
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:
1801232483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9370 SW GREENBURG RD
Provider Second Line Business Mailing Address:
STE J
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-5408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-246-6666
Provider Business Mailing Address Fax Number:
503-246-9465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 NW SLERET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030-5504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-246-6666
Provider Business Practice Location Address Fax Number:
503-246-9465
Provider Enumeration Date:
05/22/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
USHER
Authorized Official First Name:
SHAUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
503-246-6666

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X , with the licence number:  MD00038333 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PERMANENTLY-CLOSED . This is a "PERMANENTLY CLOSED" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: PERMANENTLY-CLOSED . This is a "PERMANENTLY CLOSED" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".