Organization
NORTHWEST DIAGNOSTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET HETHERINGTON (EXCECUTIVE MANAGER)
(541) 622-6088
Entity
Organization
Contact information
Practice address
2728 W MAIN ST, SUITE 121, MEDFORD, OR 97501-2499
(541) 622-6088
(541) 622-6090
Mailing address
2728 W MAIN ST, SUITE 121, MEDFORD, OR 97501-2499
(541) 622-6088
(541) 622-6090
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
12-35846
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R163709
MEDICARE PTAN
OR
Enumeration date
02/10/2011
Last updated
12/09/2013
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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