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General NPI Number Information
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NPI Number | 1780742114
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 1515 PORTLAND RD
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City | NEWBERG
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State | OR
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Zip | 97132-1844
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Country | US
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Telephone | 503-537-1818
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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 |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY ENROLLMENT
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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 | 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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