Provider Demographics
NPI:1043241581
Name:OREGON IMAGING CENTERS, L.L.C.
Entity Type:Organization
Organization Name:OREGON IMAGING CENTERS, L.L.C.
Other - Org Name:OREGON IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHALTRAW
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:541-334-7555
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440
Mailing Address - Country:US
Mailing Address - Phone:541-687-7134
Mailing Address - Fax:541-334-6144
Practice Address - Street 1:1200 HILYARD ST
Practice Address - Street 2:#330
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-687-7134
Practice Address - Fax:541-334-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR052964Medicaid
ORCS7949Medicare PIN
OR0000WCPGHMedicare PIN