Legacy Clinic Woodburn

NPI #1821260860 in Woodburn, Oregon

Provider Information

NPI Number
1821260860
Entity Type
Organization
Organization Name
Legacy Clinic Woodburn
Subpart
Yes (part of a larger organization)
Parent Organization
MEDVANTX, INC.
Primary Specialty
Non-Pharmacy Dispensing Site
Enumeration Date
Mar 31, 2008
Last Updated
Oct 22, 2012

Practice Location

Address
1002 N BOONES FERRY RD
State
Oregon
ZIP Code
97071-9602
Phone
(503) 981-9526

Authorized Official

Name
KENNY HEINE
Title
DIRECTOR OF OPERATIONS
Phone
(858) 625-2990

Specialties & Taxonomy Codes

Specialty
Non-Pharmacy Dispensing Site

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