1790705275 NPI number — LEGACY SALMON CREEK HOSPITAL

Table of content: (NPI 1790705275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790705275 NPI number — LEGACY SALMON CREEK HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY SALMON CREEK HOSPITAL
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:
APOTHECARY AT SALMON CREEK
Provider Other Organization Name Type Code:
3
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:
1790705275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4037
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:
97208-4037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-413-3958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 E 139TH ST
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98686-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-487-3700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOFF
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SR VP AND CFO
Authorized Official Telephone Number:
503-415-5730

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  CF00058293 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4931552 . This is a "NCPDP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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