# PROVIDENCE HEALTH & SERVICES - OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVIDENCE MEDICAL GROUP, Providence Medical Group Happy Valley Immediate Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245567809
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 16180 SE SUNNYSIDE RD, SUITE 102, HAPPY VALLEY, OR 97015-6302
- **Practice address phone:** (503) 582-4975
- **Practice address fax:** (503) 582-4999
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/03/2009
- **Last updated:** 06/20/2025