Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP SOUTH
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1619 NW HAWTHORNE AVE, SUITE 206, GRANTS PASS, OR 97526-6008
(541) 732-7850
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(541) 732-7850
(541) 732-7851
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500668065
—
OR
Enumeration date
01/08/2014
Last updated
11/19/2025
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