# PROVIDENCE HEALTH & SERVICES - OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVIDENCE MEDICAL GROUP, Providence Integrative Medicine East
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447652797
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 525-5392

## Contact information

- **Practice address:** 4805 NE GLISAN ST, 1ST FLOOR, NORTH TOWER, PORTLAND, OR 97213-2933
- **Practice address phone:** (503) 215-3219
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202D00000X | Integrative Medicine Physician | — | NULL | Yes |
| 202D00000X | Integrative Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/18/2014
- **Last updated:** 06/30/2025