Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
PMG SOUTH PHYSIATRY
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
827 SPRING ST, MEDFORD, OR 97504-6111
(541) 732-8360
(541) 732-8361
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 732-8360
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500613379
—
OR
Enumeration date
04/03/2009
Last updated
11/19/2025
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