# PROVIDENCE HEALTH & SERVICES OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PMG SOUTH MEDFORD FAMILY PRACTICE, PROVIDENCE MEDICAL GROUP SOUTH
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386713972
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1698 E MCANDREWS RD, SUITE 300, MEDFORD, OR 97504-5589
- **Practice address phone:** (541) 732-7950
- **Practice address fax:** (541) 732-7901
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180
- **Mailing address phone:** (425) 358-9786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 11/19/2025