Organization
LEGACY MOUNT HOOD MEDICAL CENTER
Active
Other names
Legacy Mt. Hood Radiology
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA S. VUKOVICH (SR. VP/CFO)
(503) 415-5370
Entity
Organization
Contact information
Practice address
24800 SE STARK ST, GRESHAM, OR 97030-3378
(503) 674-1233
(503) 674-1647
Mailing address
PO BOX 10768, PORTLAND, OR 97296-0768
(503) 674-1233
(503) 674-1647
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
14 1337
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240079
—
OR
Enumeration date
08/04/2006
Last updated
08/22/2020
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