Portland Medical Diagnostic Center Inc

Primary specialty

ContractorTaxonomy code 171W00000X

Legal business name

PORTLAND MEDICAL DIAGNOSTIC CENTER INC

Practice address

13232 SE Stark St
Suite 4
Portland, OR 97233-1573

Phone

(503) 408-7578

Fax

(503) 408-7615

NPI assigned

Oct 15, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

George Macias

Title

Secretary

Phone

(503) 408-7578

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark D Reploeg, M.D.

  • Clinical Neurophysiology Physician
  • Corvallis, OR
  • NPI 1831148592
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1235464868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13232 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331573",
            "telephone_number": "503-408-7578",
            "fax_number": "503-408-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13232 SE STARK ST",
            "address_2": "SUITE 4",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331573",
            "telephone_number": "503-408-7578",
            "fax_number": "503-408-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND MEDICAL DIAGNOSTIC CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-15",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "MACIAS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "503-408-7578"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portland Joint Reconstruction Clinic, P.C.
• Portland Lifestyle Counseling, LLC
• Portland Massage and Chiropractic Services LLC
• Portland Massage Arts LLC
• Portland Massage LLC
• Portland Medical Imaging LLC
• Portland Modern Dentistry, PC
• Portland Natural Medicine, Inc
• Portland NE 11325 of Cascadia, LLC
• Portland Neurodivergent Clinic LLC

• Contractor in Portland, OR
• Providers in Portland, OR by specialty
• Contractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.