Healthcare Provider Details

I. General information

NPI: 1386919132
Provider Name (Legal Business Name): LEGACY MOUNT HOOD MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24800 SE STARK ST
GRESHAM OR
97030-3378
US

IV. Provider business mailing address

PO BOX 4365
PORTLAND OR
97208-4365
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-5089
  • Fax: 503-413-1860
Mailing address:
  • Phone: 503-413-3958
  • Fax: 503-413-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LINDA HOFF
Title or Position: SENIOR VP AND CFO
Credential:
Phone: 503-415-5730