# PROVIDENCE HEALTH & SERVICES OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164623401
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 4400 NE HALSEY ST, PORTLAND, OR 97213-1545
- **Practice address phone:** (503) 893-6524
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/31/2007
- **Last updated:** 06/20/2025