Organization
OPEN ADVANCED MRI OF GRESHAM PS
Active
Other names
PERMANENTLY CLOSED
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAUN USHER (OPERATIONS MANAGER)
(503) 246-6666
Entity
Organization
Contact information
Practice address
1026 NW SLERET AVE, GRESHAM, OR 97030-5504
(503) 246-6666
(503) 246-9465
Mailing address
9370 SW GREENBURG RD, STE J, PORTLAND, OR 97223-5408
(503) 246-6666
(503) 246-9465
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
MD00038333
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PERMANENTLY-CLOSED
PERMANENTLY CLOSED
OR
01
—
PERMANENTLY-CLOSED
PERMANENTLY CLOSED
WA
Enumeration date
05/22/2013
Last updated
08/17/2021
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