Provider Demographics
NPI:1023305034
Name:LEGACY MERIDIAN PARK HOSPITAL
Entity type:Organization
Organization Name:LEGACY MERIDIAN PARK HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-415-5145
Mailing Address - Street 1:PO BOX 6689
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-6689
Mailing Address - Country:US
Mailing Address - Phone:503-413-3958
Mailing Address - Fax:503-413-3212
Practice Address - Street 1:19300 SW 65TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7706
Practice Address - Country:US
Practice Address - Phone:503-692-1212
Practice Address - Fax:503-691-0919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY MERIDIAN PARK HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-29
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty