Provider Demographics
NPI:1750374922
Name:BODYVIEW ADVANCED DIAGNOSTIC SCANNING, LLC
Entity type:Organization
Organization Name:BODYVIEW ADVANCED DIAGNOSTIC SCANNING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:503-653-7226
Mailing Address - Street 1:13540 SE 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7691
Mailing Address - Country:US
Mailing Address - Phone:503-653-7226
Mailing Address - Fax:503-653-6791
Practice Address - Street 1:13540 SE 97TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7691
Practice Address - Country:US
Practice Address - Phone:503-653-7226
Practice Address - Fax:503-653-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269694Medicaid
ORR114375Medicare PIN