Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
PMG SOUTH DIABETES EDUCATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1698 E MCANDREWS RD, SUITE 170, MEDFORD, OR 97504-5589
(541) 732-6957
(541) 732-7901
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500616621
DMAP
OR
01
—
CG6801
RAIL ROAD MEDICARE
OR
Enumeration date
11/07/2006
Last updated
11/19/2025
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