Provider Demographics
NPI:1700809829
Name:LEGACY SALMON CREEK HOSPITAL
Entity Type:Organization
Organization Name:LEGACY SALMON CREEK HOSPITAL
Other - Org Name:
Other - Org Type:
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:PO BOX 4037
Mailing Address - Street 2:
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 1:2211 NE 139TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686
Practice Address - Country:US
Practice Address - Phone:360-487-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246YR1600X, 261Q00000X, 261QX0203X
WAH208282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record AdministratorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027978Medicaid
WA1016776Medicaid
CAXHSP43730Medicaid
AKHS277OPMedicaid
CAXHSP33730Medicaid
150485000OtherREGENCE BLUE CROSS
WA3300530Medicaid
WA7132582Medicaid
ID807374900Medicaid
WAG8857710Medicare PIN
WA3300530Medicaid
ID807374900Medicaid
WAG8857757Medicare PIN