Provider Demographics
NPI:1538107941
Name:BRIDGEPORT MRI LLC
Entity Type:Organization
Organization Name:BRIDGEPORT MRI LLC
Other - Org Name:CLEARVIEW MRI BRIDGEPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-774-7700
Mailing Address - Street 1:15755 SW SEQUOIA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7166
Mailing Address - Country:US
Mailing Address - Phone:503-747-4868
Mailing Address - Fax:503-639-9710
Practice Address - Street 1:15755 SW SEQUOIA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7166
Practice Address - Country:US
Practice Address - Phone:503-639-9700
Practice Address - Fax:503-639-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213180Medicaid
OR136708Medicare PIN