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Organization
PROVIDENCE MEDFORD MEDICAL CENTER
Active
Organization
PROVIDENCE MEDFORD MEDICAL CENTER
Active
Other names
Providence Medford Medical Center Lifeline
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1111 CRATER LAKE AVENUE, MEDFORD, OR 97504-6214
(541) 732-5000
(541) 732-5131
Mailing address
P.O. BOX 3308, PORTLAND, OR 97208-3308
(503) 215-4050
(503) 215-4343
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
OR
282N00000X
General Acute Care Hospital
140734
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227950
—
OR
Enumeration date
06/27/2006
Last updated
05/07/2025
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