Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Portland Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Mailing address
PO BOX 31001-4199, PASADENA, CA 91110-4199
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207ZC0006X
Clinical Pathology Physician
Primary
—
—
2085B0100X
Body Imaging Physician
—
—
Other
Enumeration date
10/26/2016
Last updated
05/14/2025
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