| Northwest Diagnostic Services | |
|
2728 W Main St Suite 121 Medford OR 97501-2499 | |
| (541) 622-6088 | |
| (541) 622-6090 |
| Full Name | Northwest Diagnostic Services |
|---|---|
| Speciality | Clinic/center |
| Location | 2728 W Main St, Medford, Oregon |
| Authorized Official Name and Position | Janet Hetherington (EXCECUTIVE MANAGER) |
| Authorized Official Contact | 5416226088 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Diagnostic Services 2728 W Main St Suite 121 Medford OR 97501-2499 Ph: (541) 622-6088 | Northwest Diagnostic Services 2728 W Main St Suite 121 Medford OR 97501-2499 Ph: (541) 622-6088 |
| NPI Number | 1497051320 |
|---|---|
| Provider Enumeration Date | 02/10/2011 |
| Last Update Date | 12/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497051320 | NPI | - | NPPES |
| R163709 | Other | OR | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 12-35846 (Oregon) | Primary |
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