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DSH380060G Portland Adventist Medical Center dba Adventist Health Portland (Active)
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Main Details
Name
Portland Adventist Medical Center dba Adventist Health Portland
Subdivision Name
PORTLAND ADVENTIST MEDICAL CENTER - Cardiac Cathetrization Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380060G
Medicare Provider Number
380060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2021
Participating Start Date
4/1/2021
Participating Approval Date
3/10/2021
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Portland Adventist Medical Center dba Adventist Health Portland
Jason Panasuk, Finance Officer
(503) 251-6121
Primary Contact
Adventist Health Portland
Rochelle Ford, Clinical Coordinator
(503) 261-6505
Addresses
Street Address
10000 SE MAIN ST
PORTLAND, OR 97216-2474
Billing Address
Portland Adventist Medical Center
10000 SE Main St
Portland, OR 97216
Comments
Medicaid Billing
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