Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence The Dalles ENT, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1815 E 19TH ST, SUITE 1, THE DALLES, OR 97058-3385
(541) 298-5563
Mailing address
PO BOX 31001-4180, PASADENA, CA 91110-4118
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500650976
—
OR
Enumeration date
08/30/2012
Last updated
06/20/2025
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