Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
Prov Health Sys-OR Shared-Svs Div
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
2033 COMMERCE DR, MEDFORD, OR 97504-9744
(541) 732-6500
Mailing address
4400 NE HALSEY ST, BUILDING 1, STE 129, PORTLAND, OR 97213-1545
(503) 215-4601
(503) 215-4624
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026699000
BLUE CROSS FFS
OR
01
—
084013000
BLUE CROSS HOSPICE PD
OR
05
—
132204
—
OR
01
—
303804000001
PHP
OR
01
—
930386912-03
ODS
OR
Enumeration date
10/03/2006
Last updated
05/16/2025
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