Provider Demographics
NPI:1558449504
Name:MEDICAL IMAGING GROUP OF HILLSBORO
Entity Type:Organization
Organization Name:MEDICAL IMAGING GROUP OF HILLSBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-681-1106
Mailing Address - Street 1:PO BOX 28130
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-8130
Mailing Address - Country:US
Mailing Address - Phone:503-681-1000
Mailing Address - Fax:503-681-1796
Practice Address - Street 1:335 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4246
Practice Address - Country:US
Practice Address - Phone:503-681-1000
Practice Address - Fax:503-681-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
OR0666431 7261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR076778Medicaid
OR076778Medicaid