Legacy Laboratory Services, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

38D0625165 Issued in OR

Legal business name

LEGACY LABORATORY SERVICES, LLC

Practice address

1225 NE 2ND Ave
Portland, OR 97232-2003

Phone

(503) 413-5050

Fax

(503) 413-3212

NPI assigned

Oct 28, 2008

Last updated

Apr 14, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

LEGACY EMANUEL HOSPITAL AND HEALTH CENTERAs reported in NPPES

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

Authorized official

Name

Pamela S Vuckovich

Title

Sr VP and Cfo

Phone

(503) 415-5730

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Part of

Legacy Emanuel Hospital Health Center

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Legacy Emanuel Hospital & Health Center

  • Clinic/Center
  • Portland, OR
  • NPI 1700809027

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239667200000",
    "number": "1902059538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5337",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972285337",
            "telephone_number": "503-413-4420",
            "fax_number": "503-413-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 NE 2ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322003",
            "telephone_number": "503-413-5050",
            "fax_number": "503-413-3212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY LABORATORY SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY EMANUEL HOSPITAL AND HEALTH CENTER",
        "enumeration_date": "2008-10-28",
        "last_updated": "2009-04-14",
        "status": "A",
        "authorized_official_last_name": "VUCKOVICH",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SR VP AND CFO",
        "authorized_official_telephone_number": "503-415-5730"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OR",
            "license": "38D0625165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Legacy Good Samaritan Hospital and Medical Center (Legacy Good Samaritan Providers)
• Legacy Good Samaritan Hospital and Medical Center
• Legacy Good Samaritan Hospital and Medical Center
• Legacy Health
• Legacy Health System
• Legacy Outpatient Imaging LLC
• Legacy United Home Care LLC
• Annie Mae Legard, PA-C
• Quinn Elspeth Legg
• Veronica Legg, FNP

• Clinical Medical Laboratory in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Medical Laboratory in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.