1316129232 NPI number — LEGACY EMANUEL HOSPITAL & HEALTH CENTER

Table of content: (NPI 1316129232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316129232 NPI number — LEGACY EMANUEL HOSPITAL & HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316129232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97208-4399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-413-3900
Provider Business Mailing Address Fax Number:
503-413-3710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N COLUMBIA RIVER HWY STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT HELENS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97051-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-397-0471
Provider Business Practice Location Address Fax Number:
503-413-3212
Provider Enumeration Date:
12/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CFO
Authorized Official Telephone Number:
503-415-5145

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  NA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 213294 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".