Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, PROVIDENCE ST VINCENT HEART CLINICS CARDIOLOGY ASTORIA
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SEC FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1355 EXCHANGE ST, ASTORIA, OR 97103-3980
(503) 836-4600
(503) 836-4613
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
—
500622010
—
OR
Enumeration date
04/23/2010
Last updated
07/04/2025
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