Provider Demographics
NPI:1700814365
Name:OREGON CARDIOLOGY DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:OREGON CARDIOLOGY DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-684-3761
Mailing Address - Street 1:1180 PATTERSON ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3619
Mailing Address - Country:US
Mailing Address - Phone:541-465-4801
Mailing Address - Fax:
Practice Address - Street 1:1180 PATTERSON ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3619
Practice Address - Country:US
Practice Address - Phone:541-465-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114205Medicare PIN