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Organization

PROVIDENCE HEALTH & SERVICE - OREGON

Active
Other names
Providence Heart Clinic Cardiovascular Surgery East, PROVIDENCE MEDICAL GROUP
Organization subpart
No

Provider details

NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization

Contact information

Practice address
5050 NE HOYT ST, SUITE 511, PORTLAND, OR 97213-2984
(503) 962-1020
(503) 962-1021
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
261Q00000X
Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500643323
OR
Enumeration date
03/06/2012
Last updated
06/30/2025
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