Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PMG SOUTH MEDFORD FAMILY PRACTICE, PROVIDENCE MEDICAL GROUP SOUTH
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
1698 E MCANDREWS RD, SUITE 300, MEDFORD, OR 97504-5589
(541) 732-7950
(541) 732-7901
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(425) 358-9786
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288499
—
OR
01
—
CG6801
RAILROAD MEDICARE
OR
Enumeration date
11/07/2006
Last updated
11/19/2025
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