Provider Demographics
NPI:1275655755
Name:MEDFORD OPEN MRI, LLC
Entity Type:Organization
Organization Name:MEDFORD OPEN MRI, LLC
Other - Org Name:BROOKINGS OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUJIOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-586-0153
Mailing Address - Street 1:205 LIBERTY ST NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3586
Mailing Address - Country:US
Mailing Address - Phone:503-586-0153
Mailing Address - Fax:
Practice Address - Street 1:555 5TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9702
Practice Address - Country:US
Practice Address - Phone:541-469-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)