Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
PROVIDENCE PSYCHIATRY WEST, PROVIDENCE MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9155 SW BARNES RD, STE 333, PORTLAND, OR 97225-6625
(503) 216-5102
(503) 216-2485
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
OR
2084P0804X
Child & Adolescent Psychiatry Physician
—
OR
2084P0805X
Geriatric Psychiatry Physician
—
OR
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
245786
—
OR
05
—
500601075
—
OR
Enumeration date
12/31/2007
Last updated
06/20/2025
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