Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Heart Clinic East at PPMC, PROVIDENCE MEDICAL GROUP
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
4805 NE GLISAN ST, SUITE 1G08, PORTLAND, OR 97213-2933
(503) 962-1000
(503) 962-1005
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
02/21/2013
Last updated
07/01/2025
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