Provider Demographics
NPI:1861447450
Name:OPEN ADVANCED MRI OF PORTLAND, LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF PORTLAND, 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:503-407-4697
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 1:9370 SW GREENBURG RD
Practice Address - Street 2:#J
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5442
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:2006-05-23
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134473Medicaid
WA7088594Medicaid
WA7088594Medicaid
OR134473Medicaid