1689919573 NPI number — OREGON ADVANCED IMAGING, LLC

Table of content: MR. MICHAEL JOSHUA MULVANY CDCA (NPI 1902481435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689919573 NPI number — OREGON ADVANCED IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OREGON ADVANCED IMAGING, LLC
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:
1689919573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
881 OHARE PKWY
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:
97504-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-622-6322
Provider Business Mailing Address Fax Number:
541-773-7009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 S FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL POINT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97502-2779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-732-8229
Provider Business Practice Location Address Fax Number:
541-773-7009
Provider Enumeration Date:
12/03/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUNDLACH
Authorized Official First Name:
LYNETTE
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
COMPTROLLER
Authorized Official Telephone Number:
541-622-6322

Provider Taxonomy Codes

  • Taxonomy code: 2471M1202X , with the licence number:  067493-94 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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