Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE MEDCIAL GROUP, Providence St Vincent Heart Clinics Cardiology Doctors Clinic Salem
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SEC ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
5050 SKYLINE VILLAGE LOOP S, SALEM, OR 97306-9490
(503) 291-2123
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500630291
—
OR
Enumeration date
06/23/2010
Last updated
07/04/2025
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