Provider Demographics
NPI:1255472569
Name:SIKER IMAGING, LLC
Entity Type:Organization
Organization Name:SIKER IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-614-0603
Mailing Address - Street 1:1800 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3932
Mailing Address - Country:US
Mailing Address - Phone:503-614-0602
Mailing Address - Fax:503-617-4549
Practice Address - Street 1:1800 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3932
Practice Address - Country:US
Practice Address - Phone:503-614-0602
Practice Address - Fax:503-617-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22182173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277874Medicaid
OR277874Medicaid
G66450Medicare UPIN