Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
Providence Medical Group
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
4400 NE HALSEY ST,, POP 2, 3RD FLOOR, PORTLAND, OR 97213-1545
(866) 876-2783
(503) 893-6680
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
10/16/2017
Last updated
07/04/2025
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