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Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group Canby Immediate Care, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
200 S HAZEL DELL WAY, CANBY, OR 97013-7829
(503) 263-9500
Mailing address
PO BOX 31001-4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
11/03/2009
Last updated
06/20/2025
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