Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
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
4400 NE HALSEY ST, PORTLAND, OR 97213-1545
(503) 893-6524
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
05/31/2007
Last updated
06/20/2025
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