LEGACY EMANUEL HOSPITAL & HEALTH CENTER

Provider Demographics

• NPI: 1700809027
• Name: LEGACY EMANUEL HOSPITAL & HEALTH CENTER
• Entity Type: Organization
• Organization Name: LEGACY EMANUEL HOSPITAL & HEALTH CENTER
• Authorized Official - Title/Position: INTERIM CFO
• Authorized Official - First Name: SARAH
• Authorized Official - Last Name: JENSEN
• Authorized Official - Phone: 503-415-5145
• Mailing Address - Street 1: PO BOX 4399
• Mailing Address - City: PORTLAND
• Mailing Address - State: OR
• Mailing Address - Zip Code: 97208-4399
• Mailing Address - Country: US
• Mailing Address - Phone: 503-397-0471
• Practice Address - Street 1: 2800 N VANCOUVER AVE STE 230
• Practice Address - City: PORTLAND
• Practice Address - State: OR
• Practice Address - Zip Code: 97227-1668
• Practice Address - Country: US
• Practice Address - Phone: 503-397-0471
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: LEGACY EMANUEL HOSPITAL & HEALTH CENTER
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-07-26
• Last Update Date: 2018-02-27

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center		Group - Single Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Single Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Single Specialty
No	2080P0006X	Allopathic & Osteopathic Physicians	Pediatrics	Developmental - Behavioral Pediatrics	Group - Single Specialty
No	2080P0205X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Endocrinology	Group - Single Specialty
No	2080P0207X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Hematology-Oncology	Group - Single Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Single Specialty
No	208M00000X	Allopathic & Osteopathic Physicians	Hospitalist		Group - Single Specialty
No	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy	Group - Single Specialty
No	261QU0200X	Ambulatory Health Care Facilities	Clinic/Center	Urgent Care	Group - Single Specialty
No	367A00000X	Physician Assistants & Advanced Practice Nursing Providers	Advanced Practice Midwife		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OR	286524	Medicaid
OR	286771	Medicaid
OR	286863	Medicaid
OR	277802	Medicaid
OR	286824	Medicaid
OR	286911	Medicaid
OR	023133	Medicaid
OR	135207	Medicaid
OR	286728	Medicaid
OR	R114044	Medicare PIN
OR	286824	Medicaid
OR	286524	Medicaid
OR	R120767	Medicare PIN
OR	R115897	Medicare PIN
OR	R130602	Medicare PIN
OR	286771	Medicaid
OR	277802	Medicaid
OR	R113839	Medicare PIN