Provider Demographics
NPI:1598952699
Name:HEAD & NECK IMAGING NORTHWEST, LLC
Entity type:Organization
Organization Name:HEAD & NECK IMAGING NORTHWEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-391-2488
Mailing Address - Street 1:4035 12TH CUT OFF ST SE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-391-2477
Mailing Address - Fax:503-588-7454
Practice Address - Street 1:4035 12TH ST CUT OFF SE
Practice Address - Street 2:SUITE 140
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1764
Practice Address - Country:US
Practice Address - Phone:503-391-2488
Practice Address - Fax:503-588-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1302148-2261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology