MEDICARE: PROVIDENCE HEALTH & SERVICES OREGON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician

General Provider Information

NPI Number	:	1033804091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES OREGON

Provider Business Mailing Address
First Line	:	PO BOX 31001 - 4180
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4180
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 NE HALSEY ST, BLDG 2
Second Line	:	STE 599
City	:	PORTLAND
State	:	OR
Zip	:	97213-9721
Country	:	US
Telephone Number	:	503-215-2110
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY OF ENROLLMENTS
Name	:	DONALD WAYNE ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	06/20/2025

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Directions to “PROVIDENCE HEALTH & SERVICES OREGON ” Practice Location

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