Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, Providence Medical Group Tanasbourne Immediate Care
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON (ASST CORP SECRETARY FOR ENROLLMENTS)
(425) 525-5392
Entity
Organization
Contact information
Practice address
10670 NE CORNELL RD STE 101, HILLSBORO, OR 97124-9221
(503) 216-9360
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022870
—
OR
Enumeration date
09/26/2006
Last updated
03/23/2026
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