Provider Demographics
NPI:1780630277
Name:OPEN ADVANCED MRI PORTLAND II, LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI PORTLAND II, 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:PO BOX 75411
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5411
Mailing Address - Country:US
Mailing Address - Phone:503-489-1681
Mailing Address - Fax:503-723-3180
Practice Address - Street 1:735 NW 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1301
Practice Address - Country:US
Practice Address - Phone:503-220-0066
Practice Address - Fax:503-464-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7088529Medicaid
OR151060Medicaid
ORR103014Medicare PIN
470000796Medicare PIN