Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
PMG South Pulmonology, PROVIDENCE MEDICAL GROUP SOUTH
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
827 SPRING ST, MEDFORD, OR 97504-6104
(541) 732-7600
(541) 732-7601
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(541) 732-7960
(541) 732-7961
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500628691
—
OR
Enumeration date
10/18/2010
Last updated
11/19/2025
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