Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, PROVIDENCE MEDICAL GROUP MILL PLAIN
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
315 SE STONE MILL DR, SUITE 102, VANCOUVER, WA 98684-6987
(360) 816-2700
(360) 816-2710
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/12/2008
Last updated
07/04/2025
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