# PROVIDENCE HEALTH & SERVICES OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVIDENCE MEDICAL GROUP, Providence Medical Group Tanasbourne Immediate Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700987401
- **Authorized official:** DONALD WAYNE ANDERSON (ASST CORP SECRETARY FOR ENROLLMENTS)
- **Authorized official phone:** (425) 525-5392

## Contact information

- **Practice address:** 10670 NE CORNELL RD STE 101, HILLSBORO, OR 97124-9221
- **Practice address phone:** (503) 216-9360
- **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 |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 03/23/2026