Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group Gateway, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1321 NE 99TH AVE, SUITE 100, PORTLAND, OR 97220-9437
(503) 215-4050
(503) 215-4055
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198127
—
OR
Enumeration date
09/16/2006
Last updated
07/04/2025
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