Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group Scholls Pediatrics, 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
12442 SW SCHOLLS FERRY RD, SUITE 205, TIGARD, OR 97223-0804
(503) 216-9140
Mailing address
PO BOX 31001-4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
04/23/2014
Last updated
06/20/2025
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