Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
5211 NE GLISAN ST BLDG C, PORTLAND, OR 97213-3052
(503) 215-6628
(503) 215-6240
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6628
(503) 215-6240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/09/2018
Last updated
06/20/2025
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