Provider Demographics
NPI:1962849307
Name:OPEN ADVANCED MRI OF PORTLAND PS
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF PORTLAND PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LARHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-246-6666
Mailing Address - Street 1:9370 SW GREENBURG RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5442
Mailing Address - Country:US
Mailing Address - Phone:503-246-6666
Mailing Address - Fax:503-246-9465
Practice Address - Street 1:9370 SW GREENBURG RD
Practice Address - Street 2:
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:2013-05-24
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
WA8251449Medicaid
WAG8922776OtherMEDICARE PTAN
ORR171792OtherMEDICARE PTAN