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DSH380060H 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
Adventist Health Medical Center Portland Emergency Department - Emergency Department
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380060H
Medicare Provider Number
380060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2021
Participating Start Date
10/1/2021
Participating Approval Date
7/28/2021
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
10123 SE Market St
Portland, OR 97216
Billing Address
Adventist Medical Center Portland
10123 SE Market St
Portland, OR 97216
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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