Provider Demographics
NPI:1346715950
Name:PORTLAND ADVENTIST MEDICAL CENTER
Entity Type:Organization
Organization Name:PORTLAND ADVENTIST MEDICAL CENTER
Other - Org Name:ADVENTIST HEALTH PORTLAND - CHERRY PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-261-4405
Mailing Address - Street 1:PO BOX 888918
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-8918
Mailing Address - Country:US
Mailing Address - Phone:503-261-6085
Mailing Address - Fax:
Practice Address - Street 1:10201 SE MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2937
Practice Address - Country:US
Practice Address - Phone:503-255-2186
Practice Address - Fax:503-255-2194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTLAND ADVENTIST MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-10
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty