Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group - Medford Hospitalists, PROVIDENCE MEDICAL GROUP SOUTH
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-5545
(541) 732-5548
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6271
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Enumeration date
11/07/2012
Last updated
11/19/2025
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