Provider Demographics
NPI:1275505448
Name:CENTER FOR MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:CENTER FOR MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:HAZARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-292-9108
Mailing Address - Street 1:PO BOX 25278
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97298-0278
Mailing Address - Country:US
Mailing Address - Phone:503-292-9108
Mailing Address - Fax:503-292-0346
Practice Address - Street 1:10810 NE CORNELL RD STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9219
Practice Address - Country:US
Practice Address - Phone:503-216-8400
Practice Address - Fax:503-216-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OR2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269831Medicaid
ORDD7153OtherRAILROAD MEDICARE PIN
OR269831Medicaid
130581Medicare ID - Type Unspecified