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NPI Code Detail

MEDICARE: PROVIDENCE HEALTH & SERVICES OREGON

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
12084P0804XChild & Adolescent Psychiatry Physician
2261QM0855XAdolescent and Children Mental Health Clinic/Center
3207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1992138309
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 : 1511 DIVISION ST STE 101
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1589
Country : US
Telephone Number : 503-722-3705
Fax Number : 503-722-3750
Authorized Official
Title or Position : ASST SECRETARY FOR ENROLLMENTS
Name : DONALD WAYNE ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 08/21/2013
Last Update Date : 07/04/2025

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Directions to “PROVIDENCE HEALTH & SERVICES OREGON ” Practice Location

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