Provider Demographics
NPI:1316992720
Name:OPEN ADVANCED MRI LONGVIEW LLC
Entity type:Organization
Organization Name:OPEN ADVANCED MRI LONGVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEVENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-407-4697
Mailing Address - Street 1:PO BOX 75025
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5025
Mailing Address - Country:US
Mailing Address - Phone:503-657-8663
Mailing Address - Fax:503-723-3180
Practice Address - Street 1:1015 OCEAN BEACH HWY
Practice Address - Street 2:#125
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4098
Practice Address - Country:US
Practice Address - Phone:360-703-0703
Practice Address - Fax:360-703-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286358Medicaid
WA7110620Medicaid
WAGAB26987Medicare PIN
470001502Medicare PIN