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General NPI Number Information
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NPI Number | 1124325972
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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 | 02/14/2011
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 4805 NE GLISAN ST STE 11N
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City | PORTLAND
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State | OR
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Zip | 97213-2933
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Country | US
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Telephone | 503-215-1600
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Fax | 503-215-1600
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Provider Business Mailing Address
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Address Line | PO BOX 31001 - 4180
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City | PASADENA
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State | CA
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Zip | 91110-4180
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Country | US
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Telephone | 503-215-6494
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Fax | 503-215-6644
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | DONALD WAYNE 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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