Provider Demographics
NPI:1093828006
Name:SILVERTON HEALTH
Entity Type:Organization
Organization Name:SILVERTON HEALTH
Other - Org Name:LEGACY MEDICAL GROUP ORTHOPEDICS AND SPORTS MEDICINE SILVERTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-415-5145
Mailing Address - Street 1:PO BOX 3417
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3417
Mailing Address - Country:US
Mailing Address - Phone:503-873-1500
Mailing Address - Fax:503-873-1534
Practice Address - Street 1:452 WELCH ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381
Practice Address - Country:US
Practice Address - Phone:503-873-1722
Practice Address - Fax:503-874-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25349174400000X
ORMD16538174400000X
ORMD24813174400000X
ORMD25866174400000X
OR200550137NP174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI43353Medicare UPIN
ORA45551Medicare UPIN
ORD14067Medicare UPIN
ORI20400Medicare UPIN
ORS53497Medicare UPIN