Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
Providence St Vincent Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 451-3000
(503) 215-0297
Mailing address
PO BOX 31001-4199, PASADENA, CA 91110-4199
(503) 451-3000
(503) 215-0297
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207U00000X
Nuclear Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052000000001
PROVIDENCE HEALTH PLAN
OR
01
—
10051
WA DEPT OF LABOR CLINIC
OR
01
—
138000400
REGENCE HOSPITAL NUMBER
OR
05
—
193805
—
OR
01
—
194078600
US DEPT OF LABOR WC
OR
01
—
262286
MEDICAID BHS OUTPT
OR
01
—
3342067
WASHINGTON MEDICAID
OR
01
—
5988
WA DEPT OF LABOR HOSPITAL
OR
01
—
CG2504
RAILROAD MEDICARE
OR
01
—
RS0004
PART B MEDICARE PTAN
OR
Enumeration date
10/10/2006
Last updated
05/01/2025
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