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Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
PMG SOUTH EAGLE POINT, PROVIDENCE MEDICAL GROUP SOUTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1332 S SHASTA AVE, SUITE A, EAGLE POINT, OR 97524-8623
(541) 826-8160
(541) 826-8197
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(541) 826-8160
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
NULL
2084P0805X
Geriatric Psychiatry Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
Other
Enumeration date
11/02/2009
Last updated
11/19/2025
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