# PROVIDENCE HEALTH & SERVICES - OREGON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH & SERVICES - OREGON
- **Other names:** PROVIDENCE PEDIATRIC SPECIALTIES III, PROVIDENCE MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659451086
- **Legal business name:** PROVIDENCE HEALTH & SERVICES - OREGON
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECREATRY FOR ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1321 NE 99TH AVE, SUITE 200, PORTLAND, OR 97220-9436
- **Practice address phone:** (503) 216-8654
- **Practice address fax:** (503) 216-8658
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180
- **Mailing address phone:** (503) 215-6494
- **Mailing address fax:** (503) 215-6644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/17/2006
- **Last updated:** 07/04/2025