Provider Demographics
NPI:1285930545
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:
Authorized Official - Phone:541-773-2493
Mailing Address - Street 1:PO BOX 3807
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2510 NW EDENBOWER BLVD
Practice Address - Street 2:SUITE #176
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8899
Practice Address - Country:US
Practice Address - Phone:541-957-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty