LEGACY EMANUEL HOSPITAL & HEALTH CENTER

Provider Demographics

• NPI: 1831112358
• Name: LEGACY EMANUEL HOSPITAL & HEALTH CENTER
• Entity Type: Organization
• Organization Name: LEGACY EMANUEL HOSPITAL & HEALTH CENTER
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: ANNA
• Authorized Official - Last Name: LOOMIS
• Authorized Official - Phone: 503-415-5730
• Mailing Address - Street 1: PO BOX 4037
• Mailing Address - City: PORTLAND
• Mailing Address - State: OR
• Mailing Address - Zip Code: 97208-4037
• Mailing Address - Country: US
• Mailing Address - Phone: 503-413-3958
• Mailing Address - Fax: 503-413-3212
• Practice Address - Street 1: 2801 N GANTENBEIN AVE
• Practice Address - City: PORTLAND
• Practice Address - State: OR
• Practice Address - Zip Code: 97227-1623
• Practice Address - Country: US
• Practice Address - Phone: 503-413-2200
• Practice Address - Fax: 503-413-2756
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-25
• Last Update Date: 2019-07-17

Provider Licenses

State	License ID	Taxonomies
		261Q00000X, 261QP2000X, 261QU0200X, 273R00000X, 273Y00000X
OR	14-0056	282N00000X, 282N00000X
OR	2610	3416A0800X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center
No	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy
No	261QU0200X	Ambulatory Health Care Facilities	Clinic/Center	Urgent Care
No	273R00000X	Hospital Units	Psychiatric Unit
No	273Y00000X	Hospital Units	Rehabilitation Unit
No	3416A0800X	Transportation Services	Ambulance	Air Transport

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OR	055330	Medicaid
OR	055103	Medicaid
WA	1019958	Medicaid
OR	055330	Medicaid
OR	100049300	Other	REGENCE BLUE CROSS
OR	055103	Medicaid
AK	HS85IP	Medicaid
WA	7762602	Medicaid
OR	913	Other	REGENCE BLUE CROSS WAAK
OR	70000000001	Other	PROVIDENCE
AK	HS85OP	Medicaid
CA	XHSP30596	Medicaid
WA	1019958	Medicaid
ID	3339000	Medicaid
OR	197855	Medicaid
OR	R103763	Medicare PIN
OR	055330	Medicaid
OR	100049300	Other	REGENCE BLUE CROSS
CA	XHSP30596	Medicaid
AK	HS85IP	Medicaid
AK	HS85IP	Medicaid