LEGACY CLINICS LLC NPI 1902827272

NPI Information

NPI: 1902827272
Provider Name: LEGACY CLINICS LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 38D1003327

Address:
1130 NW 22ND AVE STE 220
PORTLAND, OR
ZIP 97210
Phone: (503) 413-2901
Get Directions

LEGACY CLINICS LLC is a multi-specialty clinic center in Portland, OR. LEGACY CLINICS LLC NPI is 1902827272. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1130 NW 22ND AVE STE 220
PORTLAND, OR
ZIP 97210-969
Phone: (503) 413-2901

The provider's authorized official is Anna Loomis .
The authorized official title is Cfo and has the following contact phone number (503) 415-5730.

The CLIA number assigned to this NPI record is 38D1003327 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/22/2006 and was last updated on 12/22/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0200X	Internal Medicine	Critical Care Medicine			No
2	207T00000X	Neurological Surgery				No
3	207VM0101X	Obstetrics & Gynecology	Maternal & Fetal Medicine			No
4	207VX0000X	Obstetrics & Gynecology	Obstetrics			No
5	207X00000X	Orthopaedic Surgery				No
6	2083P0901X	Preventive Medicine	Public Health & General Preventive Medicine			No
7	2085R0202X	Radiology	Diagnostic Radiology			No
8	2086S0129X	Surgery	Vascular Surgery			No
9	208M00000X	Hospitalist				No
10	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			No
11	176B00000X	Midwife				No
12	207Q00000X	Family Medicine				No
13	207QG0300X	Family Medicine	Geriatric Medicine			No
14	207R00000X	Internal Medicine				No
15	261QM1300X	Clinic/Center	Multi-Specialty	698327-81	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	277799	MEDICAID	OREGON
2	022930	MEDICAID	OREGON
3	804702000	OTHER	OREGON	REGENCE BLUE CROSS
4	286709	MEDICAID	OREGON
5	7101124	MEDICAID	WASHINGTON
6	9646449	MEDICAID	WASHINGTON
7	286822	MEDICAID	OREGON
8	286717	MEDICAID	OREGON
9	227592	MEDICAID	OREGON
10	277776	MEDICAID	OREGON
11	134334	MEDICAID	OREGON
12	226982	MEDICAID	OREGON
13	227692	MEDICAID	OREGON
14	7098429	MEDICAID	WASHINGTON
15	286482	MEDICAID	OREGON
16	7130628	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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