Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES OREGON
Other names
PMG SOUTH GENERAL SURGERY, PROVIDENCE MEDICAL GROUP SOUTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1698 E MCANDREWS RD, SUITE 160, MEDFORD, OR 97504-5589
(541) 732-7874
(541) 732-7875
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022869
—
OR
01
—
CG6801
RAIL ROAD MEDIARE
OR
Enumeration date
11/03/2006
Last updated
11/19/2025
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