Provider Demographics
NPI:1528171543
Name:SILVERTON HEALTH
Entity type:Organization
Organization Name:SILVERTON HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-415-5145
Mailing Address - Street 1:PO BOX 3417
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3417
Mailing Address - Country:US
Mailing Address - Phone:503-845-2000
Mailing Address - Fax:503-845-2384
Practice Address - Street 1:250 W MARQUAM ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9520
Practice Address - Country:US
Practice Address - Phone:503-845-2000
Practice Address - Fax:503-845-2384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVERTON HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276126Medicaid
ORR164786Medicare PIN
OR276126Medicaid