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NPI Code Detail

MEDICARE: LEGACY CLINICS LLC

MEDICARE: LEGACY CLINICS LLC
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
1261QR1300XRural Health Clinic/Center

General Provider Information

NPI Number : 1730472192
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY CLINICS LLC
Provider Business Mailing Address
First Line : PO BOX 3777
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3777
Country : US
Telephone Number : 503-413-3900
Fax Number :
Provider Business Practice Location Address
First Line : 36860 INDUSTRIAL WAY
Second Line :
City : SANDY
State : OR
Zip : 97055-7371
Country : US
Telephone Number : 503-826-0206
Fax Number :
Authorized Official
Title or Position : VP FINANCE
Name : SARAH JENSEN
Credential :
Telephone Number : 503-415-5145
Provider Enumeration Date : 05/18/2011
Last Update Date : 01/20/2026

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Directions to “LEGACY CLINICS LLC ” Practice Location

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