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NPI Code Detail

MEDICARE: PROVIDENCE HEALTH & SERVICES - OREGON

MEDICARE: PROVIDENCE HEALTH & SERVICES - OREGON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center
22084N0400XNeurology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689845489
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE HEALTH & SERVICES - OREGON
Provider Business Mailing Address
First Line : PO BOX 31001 - 4180
Second Line :
City : PASADENA
State : CA
Zip : 91110-4180
Country : US
Telephone Number : 503-215-6494
Fax Number :
Provider Business Practice Location Address
First Line : 2478 13TH ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-2522
Country : US
Telephone Number : 503-362-2481
Fax Number :
Authorized Official
Title or Position : ASSISTANT SECRETARY ENROLLMENT
Name : DONALD W ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 03/19/2008
Last Update Date : 07/04/2025

Similar Medicare Providers

1952243990 — BRICIA CRUZ GONZALES REYES CHW
Practice Location Address:
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Practice Fax: 503-371-7803
1417942012 — DR. JENNIFER ELLEN WIRSIG M.D.
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1326033945 — NINA JOANNE HYNDMAN M.D.
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1295713162 — DR. MELANIE ANNE RONAI MD
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2478 13TH ST SE
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1679505580 — ELIZABETH L KING M.D.
Practice Location Address:
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1043412091 — TIMOTHY A. MEADE MS, NCC
Practice Location Address:
2478 13TH ST SE STE 200
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Directions to “PROVIDENCE HEALTH & SERVICES - OREGON ” Practice Location

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