Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group Canby Family Medicine, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
200 S HAZEL DELL WAY, CANBY, OR 97013-7829
(503) 263-9500
(503) 263-1383
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500653371
—
OR
Enumeration date
10/25/2012
Last updated
06/20/2025
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