Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE ST VINCENT HEART CLINICS CARDIOLOGY, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9427 SW BARNES RD, STE 495, PORTLAND, OR 97225-6652
(503) 216-0900
Mailing address
PO BOX 31001-4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500622015
—
OR
Enumeration date
04/26/2010
Last updated
06/20/2025
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