# PROVIDENCE HEALTH & SERVICES - OREGON

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

## Provider details

- **NPI number:** 1841466141
- **Authorized official:** DONALD W ANDERSON JR. (ASST SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 5330 NE GLISAN ST, SUITE 100, PORTLAND, OR 97213-3069
- **Practice address phone:** (503) 215-9706
- **Mailing address:** PO BOX 31001 - 4180, PASADENA, CA 91110-4180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/06/2008
- **Last updated:** 07/04/2025