Provider Demographics
NPI:1477936599
Name:OB GYN BREAST IMAGING PC
Entity Type:Organization
Organization Name:OB GYN BREAST IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-579-5000
Mailing Address - Street 1:14780 SW OSPREY DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8028
Mailing Address - Country:US
Mailing Address - Phone:503-579-5000
Mailing Address - Fax:
Practice Address - Street 1:17050 PILKINGTON RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-6306
Practice Address - Country:US
Practice Address - Phone:503-579-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty