Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
Providence Medical Group Sunnyside, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST CORP SECRETARY FOR ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9290 SE SUNNYBROOK BLVD, SUITE 120, CLACKAMAS, OR 97015
(503) 215-2110
(503) 215-2115
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
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
09/25/2006
Last updated
06/20/2025
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