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
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