Provider Demographics
NPI:1720018393
Name:RADIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-681-8586
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-0053
Mailing Address - Country:US
Mailing Address - Phone:541-687-7134
Mailing Address - Fax:541-687-7135
Practice Address - Street 1:445 HARLOW RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1340
Practice Address - Country:US
Practice Address - Phone:541-681-8586
Practice Address - Fax:541-681-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA710762Medicaid
OR165704Medicaid
ORR000WCBDCMedicare PIN
OR165704Medicaid