MEDICARE: LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1134750037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 3808
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3808
Country	:	US
Telephone Number	:	503-413-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 NW 22ND AVE STE 250
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3057
Country	:	US
Telephone Number	:	503-413-7557
Fax Number	:	503-413-6547

Authorized Official
Title or Position	:	VP FINANCE
Name	:	SARAH JENSEN
Credential	:
Telephone Number	:	503-415-5145

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/20/2026

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