# PROVIDENCE HEALTH & SERVICES - OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVIDENCE MEDICAL GROUP, Providence Children's Development Institute at Child Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295105518
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 830 NE 47TH AVE, PORTLAND, OR 97213-2212
- **Practice address phone:** (503) 215-2233
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080P0008X | Pediatric Neurodevelopmental Disabilities Physician | — | NULL | — |
| 2080P0008X | Pediatric Neurodevelopmental Disabilities Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/29/2015
- **Last updated:** 06/20/2025