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Organization
PROVIDENCE HEALTH & SERVICE - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICE - OREGON
Active
Other names
Providence Heart Clinic Cardiovascular Surgery East, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
5050 NE HOYT ST, SUITE 511, PORTLAND, OR 97213-2984
(503) 962-1020
(503) 962-1021
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500643323
—
OR
Enumeration date
03/06/2012
Last updated
06/30/2025
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