# PROVIDENCE HEALTH & SERVICES - OREGON

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

## Provider details

- **NPI number:** 1841452521
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 525-5392

## Contact information

- **Practice address:** 18040 SW LOWER BOONES FERRY RD, SUITE 100, TIGARD, OR 97224-7215
- **Practice address phone:** (503) 216-0700
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/25/2008
- **Last updated:** 07/04/2025