| Providence Portland Medical Center | |
|
4805 Ne Glisan St Portland OR 97213-2933 | |
| (503) 215-4323 | |
| (503) 215-0297 |
| Full Name | Providence Portland Medical Center |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 4805 Ne Glisan St, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (ASSISTANT SECRETARY OF ENROLLMENTS) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Portland Medical Center Po Box 3395 Portland OR 97208-3395 Ph: (503) 215-4323 | Providence Portland Medical Center 4805 Ne Glisan St Portland OR 97213-2933 Ph: (503) 215-4323 |
| NPI Number | 1023194271 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 12/07/2023 |
| Certification Date | 12/05/2023 |
| Medicare PECOS PAC ID | 5395656284 |
|---|---|
| Medicare Enrollment ID | O20070924000493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023194271 | NPI | - | NPPES |
| 023981 | Medicaid | OR | |
| 0000ZBBVW | Other | OR | PART B MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
| 282N00000X | General Acute Care Hospital | (* (Not Available)) | Secondary |
Sandra M. Gonzalez Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1130 Sw Morrison St, Suite 411, Portland, OR 97205 Phone: 503-228-0939 Fax: 503-226-8069 | |
Cascadia Behavioral Healthcare, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9125 Sw 55th Ave, Portland, OR 97219 Phone: 503-238-0769 Fax: 503-477-4598 | |
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Wellpath Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3701 Se Milwaukie Ave Ste D, Portland, OR 97202 Phone: 503-784-2377 | |
Daniel C Donohue, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2931 Ne Broadway St, Portland, OR 97232 Phone: 503-819-2515 | |
Cultivating A New Life Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 Se Spokane St Ste 300, Portland, OR 97202 Phone: 541-904-0468 | |
Tiffany Kettermann, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2926 Ne Flanders St Ste 3c, Portland, OR 97232 Phone: 971-270-0167 |