Provider Demographics
NPI:1083590533
Name:ELITE INTERVENTIONAL RADIOLOGY CONSULTANTS OF OREGON PC
Entity type:Organization
Organization Name:ELITE INTERVENTIONAL RADIOLOGY CONSULTANTS OF OREGON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-480-2734
Mailing Address - Street 1:12421 SW SHERI AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE SUZY
Mailing Address - State:FL
Mailing Address - Zip Code:34269-5938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 NW 11TH ST STE E10
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8602
Practice Address - Country:US
Practice Address - Phone:541-667-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty