Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group, Providence Medical Group Scholls
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
12442 SW SCHOLLS FERRY RD, SUITE 100, TIGARD, OR 97223-3396
(503) 216-9200
(503) 216-9220
Mailing address
PO BOX 31001-4180, PASADENA, CA 91110-4180
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063680
—
OR
Enumeration date
09/25/2006
Last updated
06/20/2025
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