1952529620 NPI number — CORVALLIS MRI A JOINT VENTURE

Table of content: (NPI 1952529620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952529620 NPI number — CORVALLIS MRI A JOINT VENTURE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORVALLIS MRI A JOINT VENTURE
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:
1952529620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 NW SAMARITAN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97330-3737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-768-5187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3615 NW SAMARITAN DRIVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97330-3737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-768-5187
Provider Business Practice Location Address Fax Number:
541-768-5092
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAPE
Authorized Official First Name:
BECKY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
541-768-5009

Provider Taxonomy Codes

  • Taxonomy code: 2471M1202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 214502 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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