Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SECRETARY FOR ENROLLMENTS)
(425) 538-9786
Entity
Organization
Contact information
Practice address
3101 SE 192ND AVE STE 103, VANCOUVER, WA 98683-1443
(360) 666-4480
(360) 666-4485
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
01/06/2014
Last updated
07/04/2025
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