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DSH380060AA 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 Portland Infectious Disease - Infectious Disease Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380060AA
Medicare Provider Number
380060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/6/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/1/2023
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
10201 SE Main St
29
Portland, OR 97216
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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