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General NPI Number Information
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NPI Number | 1366748550
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH AND SERVICES OREGON
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 315 SE STONEMILL DR STE 220
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City | VANCOUVER
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State | WA
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Zip | 98684-6987
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Country | US
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Telephone | 360-687-6650
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Fax |
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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 | 425-358-9786
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Fax | 503-215-6271
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Authorized Official
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Title or Position | ASSISTANT SECRETARY 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 | 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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