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Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP AT ST VINCENT, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9205 SW BARNES RD, MT 2800, PORTLAND, OR 97225-6603
(503) 216-2621
(503) 216-7488
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
12/15/2006
Last updated
06/20/2025
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