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IDUAL/SOLE PROPRIETORSHIP CORPORATION OTHER If you checked Individual/Sole proprietorship, SSN is preferable to EIN. PARTNERSHIP SOCIAL SECURITY NUMBER OR FEDERAL IDENTIFICATION NUMBER CHECK HERE if EXEMPT from 1099 reporting, and check the qualifying exemption reason below: CORPORATION GOVERNMENT AGENCY OTHER COMPANY INFORMATION: LEGAL REGISTERED NAME: Business (DBA) Name if Different : CUSTOMER SERVICE INFORMA.

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How to fill out the OHSU Supplier Set Up Form online

Filling out the OHSU Supplier Set Up Form online is a crucial step for suppliers looking to establish or update their profiles. This guide will walk you through the form's components and provide clear instructions to ensure you complete it accurately and efficiently.

Follow the steps to successfully complete the form.

  1. Click the ‘Get Form’ button to access the OHSU Supplier Set Up Form and open it in your document editor.
  2. Select the type of organization you represent by checking the appropriate box: Individual/Sole Proprietorship, Corporation, Partnership, or Other. If you are an Individual/Sole Proprietorship, include your Social Security Number (SSN) where indicated.
  3. If applicable, indicate your exemption from 1099 reporting by checking the box and providing the qualifying exemption reason such as Corporation or Government Agency.
  4. Fill in the company information, particularly your legal registered name and any assumed business name (DBA) that is different.
  5. Complete the customer service information by providing the address, city, state, zip code, phone number, fax number, and customer service contact name.
  6. State your payment terms in the designated section.
  7. For tax correspondence, provide the relevant address, phone number, fax number, and contact person details.
  8. Indicate whether your company is registered as a Small Business or Minority Owned in the state of Oregon and specify the type of minority if applicable.
  9. In the services section, select whether you will provide medical, legal services, or goods such as equipment and supplies, indicating your responses accordingly.
  10. Print your name as the preparer, provide your phone number, and date the form.
  11. Once you have completed all fields, review your entries for accuracy. You can save the changes, download the form for your records, print it, or share it as necessary.

Complete the OHSU Supplier Set Up Form online today to ensure your information is current and accurate.

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General information: 503-494-8311 Patient relations. 503-494-7959. Billing and insurance. 866-617-6855. Medical records. 503-494-6288. Admissions (patients) 503-494-8927. OHSU Notice of privacy practices. 503-494-8849.

You can also call the Health Share Customer Service team at 503-416-8090, or care coordinators at OHSU Health at 844-827-6572.

For help with a referral, call our Physician Advice and Referral Service at 503-494-4567 between 7 a.m. and 7 p.m.

As Oregon's only academic health center, OHSU provides an extensive range of services, from everyday health care needs to complex, highly specialized therapies. Our knowledge translates into cures and disease prevention. Our research sparks new treatments.

The complaint process Please speak with the members of your healthcare team first. ... If you are not satisfied with the response you have received from your health care team, call Patient Relations at 503-494-7959, stop by the office to talk with our staff or fill out a patient feedback form below:

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