Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group at Marys Woods, Providence Medical Group West Linn, 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
17550 PROVOST ST STE 201, LAKE OSWEGO, OR 97034-5199
(503) 513-3350
(503) 513-3355
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(425) 358-9786
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
225100000X
Physical Therapist
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500672536
—
OR
Enumeration date
01/19/2010
Last updated
03/23/2026
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