# PROVIDENCE HEALTH & SERVICES - OREGON

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

## Provider details

- **NPI number:** 1588066906
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 525-5392

## Contact information

- **Practice address:** 9135 SW BARNES RD, SUITE 261, PORTLAND, OR 97225-6784
- **Practice address phone:** (503) 216-0246
- **Practice address fax:** (503) 216-0247
- **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:** 09/17/2014
- **Last updated:** 06/30/2025