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General NPI Number Information
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NPI Number | 1720837552
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Entity Type | Organization
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Legal Business Name | LEGACY OUTPATIENT IMAGING LLC
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Dates
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Enumeration Date | 05/14/2024
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 1919 NW LOVEJOY ST
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City | PORTLAND
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State | OR
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Zip | 97209-1503
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Country | US
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Telephone | 503-982-4350
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Fax | 503-225-8743
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Provider Business Mailing Address
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Address Line | PO BOX 3063
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City | PORTLAND
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State | OR
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Zip | 97208-3063
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Country | US
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Telephone | 503-413-3900
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ANNA LOOMIS
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Credential |
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Telephone | 503-415-5730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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