Provider Demographics
NPI:1083866933
Name:PROVIDENCE ST VINCENT HOSPITAL
Entity Type:Organization
Organization Name:PROVIDENCE ST VINCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE VERIFIER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-215-9553
Mailing Address - Street 1:1235 NE 47TH AVE
Mailing Address - Street 2:SUITE 285
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2100
Mailing Address - Country:US
Mailing Address - Phone:503-215-9553
Mailing Address - Fax:503-215-0825
Practice Address - Street 1:1235 NE 47TH AVE
Practice Address - Street 2:SUITE 285
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2100
Practice Address - Country:US
Practice Address - Phone:503-215-9553
Practice Address - Fax:503-215-0825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HEALTH & SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR193805Medicaid
OR380004Medicare PIN