# PROVIDENCE PORTLAND CANCER CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790168797
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 4805 NE GLISAN ST, SUITE 6N60, PORTLAND, OR 97213-2933
- **Practice address phone:** (503) 215-3258
- **Mailing address:** 4805 NE GLISAN ST, SUITE 6N60, PORTLAND, OR 97213-2933
- **Mailing address phone:** (503) 215-3258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | FE172129 | OR | Yes |

## Other

- **Enumeration date:** 07/08/2015
- **Last updated:** 05/07/2025