Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SECRETARY FOR ENROLLMENT)
(425) 525-5392
Entity
Organization
Contact information
Practice address
4823 MEADOWS RD, LAKE OSWEGO, OR 97035-2529
(503) 216-1580
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
09/29/2015
Last updated
06/20/2025
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