Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
Providence Infusion and Home Medical Equipment
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
840 ROYAL AVE, SUITE 120, MEDFORD, OR 97504-6461
(541) 732-5566
(541) 732-5503
Mailing address
PO BOX 5936 B, PORTLAND, OR 97228-5936
(503) 215-4663
(503) 215-4655
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Enumeration date
02/05/2010
Last updated
05/16/2025
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