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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
1251E00000XHome Health AgencyOR

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 : 1831196302
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE HEALTH & SERVICES OREGON
Provider Business Mailing Address
First Line : PO BOX 2724
Second Line :
City : PORTLAND
State : OR
Zip : 97208-2724
Country : US
Telephone Number : 503-215-4601
Fax Number : 503-215-4624
Provider Business Practice Location Address
First Line : 570 S MAIN STREET
Second Line :
City : MOUNT ANGEL
State : OR
Zip : 97362-9540
Country : US
Telephone Number : 503-845-9226
Fax Number :
Authorized Official
Title or Position : ASSISTANT SECRETARY ENROLLMENT
Name : DONALD W ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 06/30/2005
Last Update Date : 05/16/2025

Similar Medicare Providers

1417978164 — PROVIDENCE HEALTH & SERVICES OREGON
Practice Location Address:
540 S MAIN ST
MOUNT ANGEL, OR
97362-9540
Practice Phone: 503-845-6841
Practice Fax: 503-845-9229
1073718003 — MELISSA D SEVERSON OTR/L
Practice Location Address:
540 S MAIN ST
MOUNT ANGEL, OR
97362-9540
Practice Phone: 503-845-2736
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1013115559 — MS. JANET GAYLE PERRY MPT
Practice Location Address:
540 S MAIN ST , PROVIDENCE BENEDICTINE REHAB DPT
MOUNT ANGEL, OR
97362-9540
Practice Phone: 503-845-2736
Practice Fax:
1679752711 — MICHELLE FLYNN SLP
Practice Location Address:
540 S MAIN ST
MOUNT ANGEL, OR
97362-9540
Practice Phone: 503-845-6841
Practice Fax: 503-845-9229
1811163280 — DIANA LEE HENRY PT
Practice Location Address:
540 S MAIN ST
MOUNT ANGEL, OR
97362-9540
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Practice Fax: 503-845-9229
1841466216 — RHETT LEELAND RANDALL PT
Practice Location Address:
540 S MAIN ST
MOUNT ANGEL, OR
97362-9540
Practice Phone: 503-845-6841
Practice Fax: 503-845-9229

Directions to “PROVIDENCE HEALTH & SERVICES OREGON ” Practice Location

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