Provider Demographics
NPI:1043456643
Name:MEDICAL IMAGING GROUP, LLC
Entity Type:Organization
Organization Name:MEDICAL IMAGING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-216-4830
Mailing Address - Street 1:9400 SW BARNES RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6608
Mailing Address - Country:US
Mailing Address - Phone:503-797-6356
Mailing Address - Fax:503-292-0346
Practice Address - Street 1:18040 SW LOWER BOONES FERRY ROAD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224
Practice Address - Country:US
Practice Address - Phone:503-216-8440
Practice Address - Fax:503-292-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPENDING261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology