Provider Demographics
NPI:1417977976
Name:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Entity Type:Organization
Organization Name:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Other - Org Name:APOTHECARY AT EMANUEL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-415-5730
Mailing Address - Street 1:501 N GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1654
Mailing Address - Country:US
Mailing Address - Phone:503-413-4225
Mailing Address - Fax:503-413-4515
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-413-4225
Practice Address - Fax:503-413-4515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0001310-CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3805946OtherNCPDP