Provider Demographics
NPI:1609175660
Name:LEGACY SALMON CREEK HOSPITAL
Entity Type:Organization
Organization Name:LEGACY SALMON CREEK HOSPITAL
Other - Org Name:LEGACY SALMON CREEK RADIATION ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-415-5730
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2077
Mailing Address - Country:US
Mailing Address - Phone:503-413-3958
Mailing Address - Fax:503-413-3212
Practice Address - Street 1:2121 NE 139TH ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2316
Practice Address - Country:US
Practice Address - Phone:360-487-1700
Practice Address - Fax:360-487-1709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY SALMON CREEK HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-16
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8881560Medicare PIN