Organization
PROVIDENCE HEALTH & SERVICES
Active
Other names
PROVIDENCE MEDICAL GROUP, PMG NEWBERG INTERNAL MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1515 PORTLAND RD, NEWBERG, OR 97132-1844
(503) 537-1818
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022848
—
OR
Enumeration date
12/05/2006
Last updated
07/04/2025
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