Providence Health Plans Logo Providence Health Plans
**Providence Group ID #:
*Company Name:
*Your Name:
*Your Title:
*Telephone Number:
*e-mail Address:
*Re-type e-mail Address:
*Would your company like to use Employee Self Service Enrollment?
*Estimated Open Enrollment Start Date: (mm/dd) 
List additional users for Administrative access to e-Enroll and e-Bill:
First Name: Last Name: e-mail Address: Re-type e-mail Address:
       * - Required Field    ** - Required Field if you have a Providence Group ID #
Upon registering for these services your monthly premium billing information will be presented online, and your paper bill will be discontinued.




Contact PHP

Sales Team
503-574-6300 or

Membership Accounting
503-574-5754 or
M-F, 8 am to 5 pm

Mailing Address:
Providence Health Plans
P.O. Box 4327
Portland, Oregon 97208-4327

Technical Support: