Provider Demographics
NPI:1922164482
Name:EASTERN OREGON RADIOLOGY
Entity Type:Organization
Organization Name:EASTERN OREGON RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-963-8421
Mailing Address - Street 1:PO BOX 18858
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-0188
Mailing Address - Country:US
Mailing Address - Phone:775-283-3315
Mailing Address - Fax:775-624-9763
Practice Address - Street 1:900 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1362
Practice Address - Country:US
Practice Address - Phone:541-963-8421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR041077000OtherREGENCE
ORCJ6070OtherRAILROAD MEDICARE
OR194663800OtherDEPT LABOR
OR226258Medicaid
OR226258Medicaid