Provider Demographics
NPI:1801232483
Name:OPEN ADVANCED MRI OF GRESHAM PS
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF GRESHAM PS
Other - Org Name:PERMANENTLY CLOSED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-246-6666
Mailing Address - Street 1:9370 SW GREENBURG RD
Mailing Address - Street 2:STE J
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5408
Mailing Address - Country:US
Mailing Address - Phone:503-246-6666
Mailing Address - Fax:503-246-9465
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:503-246-6666
Practice Address - Fax:503-246-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038333246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPERMANENTLY-CLOSEDOtherPERMANENTLY CLOSED
ORPERMANENTLY-CLOSEDOtherPERMANENTLY CLOSED
WAH11563OtherMEDICARE