Provider Demographics
NPI:1669037982
Name:SAFE HARBOR MEDICAL INCORPORATED
Entity Type:Organization
Organization Name:SAFE HARBOR MEDICAL INCORPORATED
Other - Org Name:SERENITY OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIEGFRIED
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTHELSDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-776-0868
Mailing Address - Street 1:1026 NW SLERET AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1026 NW SLERET AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5504
Practice Address - Country:US
Practice Address - Phone:503-776-0868
Practice Address - Fax:855-940-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Single Specialty