Provider Demographics
NPI:1609822683
Name:OPEN ADVANCED MRI OF GRESHAM LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF GRESHAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEVENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-970-2892
Mailing Address - Street 1:DEPARTMENT 4888
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4888
Mailing Address - Country:US
Mailing Address - Phone:503-657-8663
Mailing Address - Fax:503-723-3180
Practice Address - Street 1:1026 NW SLERET AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-489-1674
Practice Address - Fax:503-489-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7113541Medicaid
OR286947Medicaid
470001553Medicare PIN
OR286947Medicaid