Provider Demographics
NPI:1841503109
Name:MEDFORD RADIOLOGICAL GROUP PC
Entity type:Organization
Organization Name:MEDFORD RADIOLOGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TROYCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-773-2493
Mailing Address - Street 1:PO BOX 2947
Mailing Address - Street 2:UNIT 1001
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2947
Mailing Address - Country:US
Mailing Address - Phone:559-455-4000
Mailing Address - Fax:770-776-5992
Practice Address - Street 1:648 CHETCO AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415
Practice Address - Country:US
Practice Address - Phone:541-412-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty