Provider Demographics
NPI:1639108434
Name:WILLAMETTE FALLS HOSPITAL
Entity Type:Organization
Organization Name:WILLAMETTE FALLS HOSPITAL
Other - Org Name:PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-657-6798
Mailing Address - Street 1:PO BOX 2230
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-5230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:503-650-6863
Practice Address - Street 1:1500 DIVISION ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1527
Practice Address - Country:US
Practice Address - Phone:503-657-6704
Practice Address - Fax:503-650-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00128059321500282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3012408Medicaid
ORP042001OtherPACIFIC SOURCE PROV NUM
OR1380038OtherBLUE CROSS PROVIDER NUM
WA25725OtherWA DOLI PROV NUM UB92'S
WA93940OtherWA DOLI PROV NUM 1500'S
OR0414531OtherTRIWEST PROVIDER NUMBER
OR217653Medicaid
OR217653Medicaid