Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PMG BETHANY, 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
15640 NW LAIDLAW RD, SUITE 102, PORTLAND, OR 97229-3828
(503) 764-0100
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
04/02/2007
Last updated
07/04/2025
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