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General NPI Number Information
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NPI Number | 1114015971
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES OREGON
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 9205 SW BARNES RD
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City | PORTLAND
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State | OR
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Zip | 97225-6603
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Country | US
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Telephone | 503-215-4323
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Fax | 503-215-0297
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Provider Business Mailing Address
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Address Line | PO BOX 3396
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City | PORTLAND
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State | OR
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Zip | 97208-3396
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Country | US
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Telephone | 503-215-4323
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Fax | 503-215-0297
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Authorized Official
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Title or Position | ASST SEC FOR ENROLL/DIR REIMB ADMIN
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Name | MR. DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-525-5392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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