# PROVIDENCE HEALTH & SERVICES OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PMG BRIDGEPORT IMMEDIATE CARE, PROVIDENCE MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821224957
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASST SECRETARY FOR ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 18040 SW LOWER BOONES FERRY RD, SUITE 100, TIGARD, OR 97224
- **Practice address phone:** (503) 216-0700
- **Mailing address:** PO BOX 3158, PORTLAND, OR 97208-3158

## 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:** 06/03/2009
- **Last updated:** 07/04/2025