Provider Demographics
NPI:1730160540
Name:OREGON OPEN MRI
Entity type:Organization
Organization Name:OREGON OPEN MRI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-630-9804
Mailing Address - Street 1:2784 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3159
Mailing Address - Country:US
Mailing Address - Phone:877-630-9804
Mailing Address - Fax:503-586-1300
Practice Address - Street 1:1100 SOUTHGATE
Practice Address - Street 2:STE 8
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3974
Practice Address - Country:US
Practice Address - Phone:541-276-1142
Practice Address - Fax:541-276-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9712471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134458Medicaid
OR131819Medicare ID - Type Unspecified