Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence St Vincent Heart Care Clinic Ilwaco, PROVIDENCE MEDICAL GROUP
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
174 1ST AVE N, ILWACO, WA 98624-9137
(503) 717-7850
(503) 216-0775
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
01/06/2016
Last updated
07/04/2025
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