Healthcare Provider Details

I. General information

NPI: 1871786418
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 PRINGLE RD SE
SALEM OR
97302-1532
US

IV. Provider business mailing address

PO BOX 5936A
PORTLAND OR
97228-5936
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-4027
  • Fax: 503-585-4741
Mailing address:
  • Phone: 503-215-4663
  • Fax: 503-215-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberNPC-0003127
License Number StateOR

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECRETARY ENROLLMENTS
Credential:
Phone: 425-358-9786