Provider Demographics
NPI:1972078590
Name:PORTLAND ADVENTIST MEDICAL CENTER
Entity Type:Organization
Organization Name:PORTLAND ADVENTIST MEDICAL CENTER
Other - Org Name:ADVENTIST HEALTH PORTLAND - GRESHAM STATION #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-251-6150
Mailing Address - Street 1:PO BOX 92900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0900
Mailing Address - Country:US
Mailing Address - Phone:503-261-6085
Mailing Address - Fax:
Practice Address - Street 1:831 NW COUNCIL DR STE 125
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3794
Practice Address - Country:US
Practice Address - Phone:503-661-3439
Practice Address - Fax:503-669-1360
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:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty