Provider Demographics
NPI:1891057493
Name:ADVANCED IMAGING, LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING, LLC
Other - Org Name:NORTHWEST MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TECHNOLOGIST / ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:541-570-1728
Mailing Address - Street 1:2565 NW PENDLETON PLACE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-570-1728
Mailing Address - Fax:541-405-4020
Practice Address - Street 1:2604 SOUTH MAIN ROAD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355
Practice Address - Country:US
Practice Address - Phone:541-570-1728
Practice Address - Fax:541-405-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Single Specialty