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General NPI Number Information
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NPI Number | 1841737699
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Entity Type | Organization
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Legal Business Name | LEGACY SALMON CREEK IM
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 2101 NE 139TH ST SUITE 460
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City | VANCOUVER
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State | WA
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Zip | 98686-2325
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Country | US
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Telephone | 503-413-4318
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2077
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City | PORTLAND
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State | OR
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Zip | 97208-2077
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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 | VP FINANCE
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Name | SARAH JENSEN
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Credential |
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Telephone | 503-415-5145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 60709743
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License Number State | WA
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