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
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CG6801	OTHER	OR	RAIL ROAD MEDIARE

General Provider Information

NPI Number	:	1992882500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES - OREGON

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N PHOENIX RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	OR
Zip	:	97535-9104
Country	:	US
Telephone Number	:	541-732-5760
Fax Number	:	541-732-3406

Authorized Official
Title or Position	:	ASST SECRETARY FOR ENROLLMENT
Name	:	DONALD WAYNE ANDERSON JR.
Credential	:
Telephone Number	:	425-525-5392

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	11/19/2025

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Directions to “PROVIDENCE HEALTH & SERVICES - OREGON ” Practice Location

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