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General NPI Number Information
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NPI Number | 1023098118
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH SYSTEM OREGON
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 4540 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97213-2333
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Country | US
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Telephone | 503-215-3738
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Fax | 503-215-6942
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Provider Business Mailing Address
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Address Line | 13007 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97230-2545
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Country | US
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Telephone | 503-215-6556
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Fax | 503-215-0685
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENT
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Name | MR. DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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