Provider Demographics
NPI:1396941233
Name:PACIFIC COAST IMAGING LLC
Entity type:Organization
Organization Name:PACIFIC COAST IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SABAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-338-7525
Mailing Address - Street 1:PO BOX 5329
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-0329
Mailing Address - Country:US
Mailing Address - Phone:033-437-1285
Mailing Address - Fax:503-343-7129
Practice Address - Street 1:2111 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3329
Practice Address - Country:US
Practice Address - Phone:503-338-7525
Practice Address - Fax:503-325-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006224Medicaid
OR006224Medicaid