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NPI Code Detail

MEDICARE: LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER

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
12084P0800XPsychiatry Physician
2261Q00000XClinic/Center

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
6CK6664OTHERORMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2007002000OTHERORREGENCE BLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4002868000OTHERORREGENCE BLUE CROSS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679597108
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 : 503-413-3710
Provider Business Practice Location Address
First Line : 1200 NW 23RD AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97210-2906
Country : US
Telephone Number : 503-413-7074
Fax Number :
Authorized Official
Title or Position : VP FINANCE
Name : SARAH JENSEN
Credential :
Telephone Number : 503-415-5145
Provider Enumeration Date : 07/27/2006
Last Update Date : 01/20/2026

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Directions to “LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER ” Practice Location

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