=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437925310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTLAND ADVENTIST MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2023
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10123 SE MARKET ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97216-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-251-6136
-----------------------------------------------------
Fax | 503-251-6293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 888928
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90088-8928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE OFFICER
-----------------------------------------------------
Name | JASON PANASUK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-261-4405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------