Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Parent organization
PROVIDENCE SEASIDE HOSPITAL
Other names
Providence Seaside Hospital, Providence Seaside Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE SEASIDE HOSPITAL
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
727 S WAHANNA RD, SEASIDE, OR 97138
(503) 717-7000
Mailing address
PO BOX 31001-4199, PASADENA, CA 91110-4199
(503) 215-4323
(503) 215-0297
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000138
—
OR
01
—
015560000
REGENCE BCBSO CLINIC #
OR
01
—
039607
MEDICAID CLINIC - 1500 BILLING
OR
01
—
7042567
WASHINGTON MEDICAID
OR
01
—
C13774
RAILROAD MEDICARE
OR
Enumeration date
11/20/2006
Last updated
04/29/2025
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