Basic Information
| Provider Information | |||||||||
| NPI: | 1801064100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL OREGON MAGNETIC RESONANCE IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6059 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977086059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413826633 | ||||||||
| FaxNumber: | 5413834577 | ||||||||
| Practice Location | |||||||||
| Address1: | 1531 N CANAL BLVD | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415983218 | ||||||||
| FaxNumber: | 5413834577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2008 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | HARVEY | ||||||||
| AuthorizedOfficialFirstName: | KRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5415983218 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.