Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group Battle Ground Family Medicine, 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
101 NW 12TH AVE, SUITE 107, BATTLE GROUND, WA 98604-9141
(360) 666-4480
(360) 666-4485
Mailing address
PO BOX 31001-4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500639583
—
OR
Enumeration date
07/12/2011
Last updated
06/20/2025
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