# 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:** 1568547503
- **Legal business name:** PROVIDENCE HEALTH & SERVICES OREGON
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 965 ELLENDALE DR, MEDFORD, OR 97504-8215
- **Practice address phone:** (541) 732-6000
- **Practice address fax:** (541) 732-6005
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180
- **Mailing address phone:** (503) 215-6494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |
| 2084P0805X | Geriatric Psychiatry Physician | — | NULL | — |
| 2084P0805X | Geriatric Psychiatry Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/26/2006
- **Last updated:** 11/19/2025