Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES OREGON
Other names
Providence Specialty Pharmacy Services-Infusion/SPP
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
6410 NE HALSEY ST, SUITE 400, PORTLAND, OR 97213-4742
(503) 215-4652
Mailing address
PO BOX 5936B, PORTLAND, OR 97228-5936
(503) 215-4652
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
RP-0001136-CS
OR
3336S0011X
Specialty Pharmacy
RP-0001136-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032016
—
OR
05
—
1044161
—
WA
05
—
1427132265
—
ID
05
—
1427132265
—
MT
05
—
1427132265
—
UT
05
—
PH001OR
—
AK
Enumeration date
10/25/2006
Last updated
05/16/2025
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