Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, PROVIDENCE MEDICAL GROUP MERCANTILE
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECREATRY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4004 KRUSE WAY PL STE 300, LAKE OSWEGO, OR 97035-2479
(503) 216-1500
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
225100000X
Physical Therapist
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241291
—
OR
Enumeration date
09/25/2006
Last updated
07/04/2025
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