Provider Demographics
NPI:1689919573
Name:OREGON ADVANCED IMAGING, LLC
Entity type:Organization
Organization Name:OREGON ADVANCED IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GUNDLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-622-6322
Mailing Address - Street 1:881 OHARE PKWY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4005
Mailing Address - Country:US
Mailing Address - Phone:541-622-6322
Mailing Address - Fax:541-773-7009
Practice Address - Street 1:870 S FRONT ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2779
Practice Address - Country:US
Practice Address - Phone:541-732-8229
Practice Address - Fax:541-773-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR067493-942471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty