Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Willamette Falls Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1500 DIVISION ST, OREGON CITY, OR 97045-1527
(503) 215-2364
(503) 215-2345
Mailing address
PO BOX 31001-4199, PASADENA, CA 91110-4199
(503) 215-4323
(503) 215-0297
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207U00000X
Nuclear Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
282N00000X
General Acute Care Hospital
Primary
140563
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0414531
TRIWEST PROVIDER NUMBER
OR
01
—
1380038
BLUE CROSS PROVIDER NUM
OR
05
—
217653
—
OR
01
—
25725
WA DOLI PROV NUM UB04'S
WA
01
—
3012408
MEDICAID - WA
WA
01
—
93940
WA DOLI PROV NUM 1500;S
WA
01
—
P042001
PACIFIC SOURCE PROV NUM
OR
Enumeration date
10/18/2011
Last updated
05/27/2025
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