Provider Demographics
NPI:1922253525
Name:BRIDGEPORT MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:BRIDGEPORT MEDICAL IMAGING, LLC
Other - Org Name:CENTER FOR MEDICAL IMAGING-BRIDGEPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:HAZARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-216-4830
Mailing Address - Street 1:PO BOX 25809
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97298-0809
Mailing Address - Country:US
Mailing Address - Phone:503-797-6356
Mailing Address - Fax:503-292-0346
Practice Address - Street 1:18040 SW LOWER BOONES FERRY ROAD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7259
Practice Address - Country:US
Practice Address - Phone:503-216-8440
Practice Address - Fax:503-292-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty