# PROVIDENCE HEALTH & SERVICES - OREGON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH & SERVICES - OREGON
- **Other names:** Providence Medical Group South
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1447799523
- **Legal business name:** PROVIDENCE HEALTH & SERVICES - OREGON
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1698 E MCANDREWS RD STE 160, MEDFORD, OR 97504-5590
- **Practice address phone:** (541) 732-6070
- **Practice address fax:** (541) 732-6005
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180
- **Mailing address phone:** (425) 358-9786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | OR | — |

## Other

- **Enumeration date:** 02/22/2017
- **Last updated:** 11/19/2025