LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER

Provider Demographics

• NPI: 1780608216
• Name: LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER
• Entity type: Organization
• Organization Name: LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER
• Authorized Official - Title/Position: VP FINANCE
• Authorized Official - First Name: SARAH
• Authorized Official - Last Name: JENSEN
• Authorized Official - Phone: 503-415-5145
• 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: 503-413-4048
• Mailing Address - Fax: 503-413-4449
• Practice Address - Street 1: 1015 NW 22ND AVE
• Practice Address - City: PORTLAND
• Practice Address - State: OR
• Practice Address - Zip Code: 97210-3025
• Practice Address - Country: US
• Practice Address - Phone: 503-413-7711
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-27
• Last Update Date: 2025-02-06

Provider Licenses

State	License ID	Taxonomies
		204F00000X, 261QU0200X
	NA	261Q00000X
OR	14-0027	332B00000X, 282N00000X, 282N00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	204F00000X	Allopathic & Osteopathic Physicians	Transplant Surgery		Group - Single Specialty
No	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center
No	261QU0200X	Ambulatory Health Care Facilities	Clinic/Center	Urgent Care
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OR	077404	Medicaid
WA	1018731	Medicaid
OR	079009	Medicaid
ID	0033387	Medicaid
AK	HS76OP	Medicaid
WA	7114531	Medicaid
CA	XHSP40237	Medicaid
OR	292247	Medicaid
OR	100260	Medicaid
CA	XHSP30237	Medicaid
ID	0033387	Medicaid
OR	077404	Medicaid
WA	2025955	Medicaid
OR	138001700	Other	REGENCE BLUE CROSS
WA	7008279	Medicaid
OR	R115456	Medicare PIN
OR	079009	Medicaid
CA	XHSP30237	Medicaid
WA	2025955	Medicaid
OR	R0000ZBBVL	Medicare PIN