NPIMap

Organization Active NPI

Legacy Health

  • Other Technician
  • Portland, OR
National Provider Identifier
1720537111
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Other TechnicianTaxonomy code 247200000X
Legal business name
LEGACY HEALTH
Practice address
2801 N Gantenbein Ave RM B045
Portland, OR 97227-1623
Phone
(503) 413-2762
Fax
(503) 413-4671
NPI assigned
Sep 26, 2016
Last updated
Dec 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Anna Loomis
Title
Cfo
Phone
(503) 415-5730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Other TechnicianGroup: 193400000X SINGLE SPECIALTY GROUP 247200000X Primary

Addresses

Primary practice location

2801 N Gantenbein Ave RM B045
Portland, OR 97227-1623

Mailing address

PO Box 2868
Portland, OR 97208-2868
Phone (503) 413-2762

National Provider Directory

National Provider Directory

Locations

1040 NW 22nd Ave
Ste 110
Portland, OR 97210

2801 N Gantenbein Ave
Rm B45
Portland, OR 97227
Phone (503) 413-2762

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1720537111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2868",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972082868",
            "telephone_number": "503-413-2762",
            "fax_number": "503-413-4671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 N GANTENBEIN AVE RM B045",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271623",
            "telephone_number": "503-413-2762",
            "fax_number": "503-413-4671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "LOOMIS",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "503-415-5730"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.