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General NPI Number Information
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NPI Number | 1568689701
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Entity Type | Organization
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Legal Business Name | SISTERS OF PROVIDENCE IN OREGON
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 940 ROYAL AVE SUITE 450
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City | MEDFORD
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State | OR
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Zip | 97504-6193
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Country | US
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Telephone | 541-732-7850
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3319
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City | MEDFORD
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State | OR
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Zip | 97502-0012
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Country | US
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Telephone |
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Fax |
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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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