Financial Assistance Application - Alaska

Please download the paper form and mail it, and the required documents, to:

PH&S Regional Business Office
P.O. Box 4227
Portland, OR 97208-3395

If you have any questions, please call us at:

Providence Alaska Medical Center
Kodiak Island Medical Center
855-229-6466
Monday-Friday, 8 a.m.-5:30 p.m. (PT)
Providence Anchorage Physician Billing
855-229-6466
Monday-Friday, 8 a.m.-5:30 p.m. (PT)
Providence Seward Medical & Care Center
907-224-2837
Monday-Friday: 8 a.m.-5 p.m.
Providence Valdez Medical Center
907-835-2249
Monday-Friday: 8 a.m.-4:30 p.m.

We will respond to your request via email within 14 business days of receiving it along with all required documents.