Provider Demographics
NPI:1487609426
Name:M. R . IMAGING ASSOCIATES LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:M. R . IMAGING ASSOCIATES LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-726-4959
Mailing Address - Street 1:960 N 16TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4175
Mailing Address - Country:US
Mailing Address - Phone:541-726-4959
Mailing Address - Fax:541-741-2188
Practice Address - Street 1:960 N 16TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4175
Practice Address - Country:US
Practice Address - Phone:541-726-4959
Practice Address - Fax:541-741-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182527Medicaid
OROOOOW-CJDBMedicare ID - Type Unspecified