Organization
LEGACY CLINICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH JENSEN (VP FINANCE)
(503) 415-5145
Entity
Organization
Contact information
Practice address
1130 NW 22ND AVE STE 220, PORTLAND, OR 97210-2969
(503) 413-2901
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
—
—
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
207VX0000X
Obstetrics Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
698327-81
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022930
—
OR
05
—
134334
—
OR
05
—
226982
—
OR
05
—
227592
—
OR
05
—
227692
—
OR
05
—
277776
—
OR
05
—
277799
—
OR
05
—
286482
—
OR
05
—
286709
—
OR
05
—
286717
—
OR
05
—
286822
—
OR
05
—
7098429
—
WA
05
—
7101124
—
WA
05
—
7130628
—
WA
01
—
804702000
REGENCE BLUE CROSS
OR
05
—
9646449
—
WA
Enumeration date
07/22/2006
Last updated
01/20/2026
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