Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
Providence Specialty Pharmacy Services-LTC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
6410 NE HALSEY ST, SUITE 400, PORTLAND, OR 97213-4742
(503) 215-4633
(503) 215-0576
Mailing address
PO BOX 5936B, PORTLAND, OR 97228-5936
(503) 215-5033
(503) 215-0542
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
IP0001899-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233012
—
OR
01
—
3815315
NCPDP
—
Enumeration date
10/25/2006
Last updated
05/16/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up