Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
Providence Medford Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(503) 215-4323
(503) 215-0297
Mailing address
PO BOX 31001-4199, PASADENA, CA 91110-4199
(503) 215-4323
(503) 215-0297
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000ZGBJC
PART B MEDICARE PTAN
OR
05
—
286211
—
OR
Enumeration date
10/23/2006
Last updated
05/27/2025
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