Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
Providence Health Sys-OR Shared Svs Div
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
2033 COMMERCE DR, MEDFORD, OR 97504-9744
(541) 732-6500
(541) 732-6504
Mailing address
4400 NE HALSEY ST, BUILDING 1, STE 129, PORTLAND, OR 97213-1545
(503) 215-4601
(503) 215-4624
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
13-140734
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019773
—
OR
01
—
026699000
BLUE CROSS
OR
01
—
303804000001
PROVIDENCE HEALTH PLAN
OR
01
—
930386912-05
ODS
OR
Enumeration date
09/28/2006
Last updated
05/15/2025
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