Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Health eXpress BP, PROVIDENCE MEDICAL GROUP SOUTH
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
4400 NE HALSEY, BLDG 2 3RD FLR, PORTALND, OR 97213
(855) 229-6460
(503) 216-0710
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/16/2013
Last updated
03/25/2026
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