# PROVIDENCE HEALTH & SERVICES - OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Medical Group Gateway Family & Community Medicine, PROVIDENCE MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124129903
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1321 NE 99TH AVE, SUITE 200, PORTLAND, OR 97220-9439
- **Practice address phone:** (503) 215-4250
- **Practice address fax:** (503) 215-4255
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180
- **Mailing address phone:** (503) 215-6446
- **Mailing address fax:** (503) 215-6644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 06/20/2025