Organization
PROVIDENCE HEALTH AND SERVICES OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
315 SE STONEMILL DR STE 220, VANCOUVER, WA 98684-6987
(360) 687-6650
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(425) 358-9786
(503) 215-6271
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
02/04/2011
Last updated
06/30/2025
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