Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE PSYCHIATRY EAST, PROVIDENCE MEDICAL GROUP
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
5251 NE GLISAN ST, BLDG A, 2ND FLOOR, PORTLAND, OR 97213-3052
(503) 215-4860
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
OR
2084P0804X
Child & Adolescent Psychiatry Physician
—
OR
2084P0805X
Geriatric Psychiatry Physician
—
OR
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500601335
—
OR
05
—
500611962
—
OR
Enumeration date
08/29/2008
Last updated
06/20/2025
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