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General NPI Number Information
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NPI Number | 1184729329
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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 | 09/13/2006
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 16770 SW EDY RD SUITE 102
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City | SHERWOOD
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State | OR
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Zip | 97140-9679
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Country | US
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Telephone | 503-216-9600
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Fax | 503-216-9650
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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 | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 208000000X
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Taxonomy Name | Pediatrics 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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry 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 | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry 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 | 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 #6
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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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