Provider Demographics
NPI:1902261753
Name:NORTHWEST IMAGING FORUMS, INC.
Entity Type:Organization
Organization Name:NORTHWEST IMAGING FORUMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:541-683-4930
Mailing Address - Street 1:PO BOX 25909
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0461
Mailing Address - Country:US
Mailing Address - Phone:541-683-4930
Mailing Address - Fax:541-683-8499
Practice Address - Street 1:1504 EYRIE LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-7560
Practice Address - Country:US
Practice Address - Phone:541-683-4930
Practice Address - Fax:541-683-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR612449256OtherDUNS NUMBER