Provider Demographics
NPI:1356685010
Name:SIKER IMAGING WEST, LLC
Entity Type:Organization
Organization Name:SIKER IMAGING WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-595-3967
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:503-595-3967
Mailing Address - Fax:503-595-3937
Practice Address - Street 1:9775 SW WILSHIRE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5067
Practice Address - Country:US
Practice Address - Phone:503-595-3967
Practice Address - Fax:503-595-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD221822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG64450Medicare UPIN