Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROV PEDS NEUROLOGY SALEM, PROVIDENCE MEDICALGROUP
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
2478 13TH ST SE, SALEM, OR 97302-2522
(503) 362-2481
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279131
—
OR
Enumeration date
03/19/2008
Last updated
07/04/2025
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