Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Center for Advanced Heart Disease, PROVIDENCE MEDICAL GROUP
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
9427 SW BARNES RD, STE 495, PORTLAND, OR 97225-6652
(503) 216-1182
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500669835
—
OR
Enumeration date
05/27/2011
Last updated
07/04/2025
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