NPIMap

Organization Active NPI

Legacy Mount Hood Medical Center

  • Diagnostic Radiology Physician
  • Gresham, OR
National Provider Identifier
1104834969
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
14 1337 Issued in OR
Legal business name
LEGACY MOUNT HOOD MEDICAL CENTER
Practice address
24800 SE Stark St
Gresham, OR 97030-3378
Phone
(503) 674-1233
Fax
(503) 674-1647
NPI assigned
Aug 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Pamela S. Vukovich
Title
Sr. VP/Cfo
Phone
(503) 415-5370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 14 1337 OR Primary

Addresses

Primary practice location

24800 SE Stark St
Gresham, OR 97030-3378

Mailing address

PO Box 10768
Portland, OR 97296-0768
Phone (503) 674-1233

Other identifiers 1

IdentifierTypeStateIssuer
240079MedicaidOR

Other names 1

  • Legacy Mt. Hood Radiology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Legacy Mount Hood Med CNTR3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

24800 SE Stark St
Gresham, OR 97030
Phone (503) 413-8407

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104834969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10768",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972960768",
            "telephone_number": "503-674-1233",
            "fax_number": "503-674-1647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24800 SE STARK ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303378",
            "telephone_number": "503-674-1233",
            "fax_number": "503-674-1647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MOUNT HOOD MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VUKOVICH",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "SR. VP/CFO",
        "authorized_official_telephone_number": "503-415-5370"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "14 1337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240079",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Mt. Hood Radiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.