Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
Providence St. Vincent Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
MR. DONALD W ANDERSON JR. (DIR REIMB REG STRAT/ASST SEC ENROLL)
(425) 525-5392
Entity
Organization
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 215-4323
(503) 215-0297
Mailing address
PO BOX 3396, PORTLAND, OR 97208-3396
(503) 215-4323
(503) 215-0297
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RS0004
PART B MEDICARE PTAN
OR
Enumeration date
10/20/2006
Last updated
08/04/2020
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