| Providence Health & Services Oregon | |
|
1698 E Mcandrews Rd Suite 300 Medford OR 97504-5589 | |
| (541) 732-7950 | |
| (541) 732-7901 |
| Full Name | Providence Health & Services Oregon |
|---|---|
| Speciality | Family Medicine |
| Location | 1698 E Mcandrews Rd, Medford, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY ENROLLMENT) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health & Services Oregon Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Health & Services Oregon 1698 E Mcandrews Rd Suite 300 Medford OR 97504-5589 Ph: (541) 732-7950 |
| NPI Number | 1386713972 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 05/12/2025 |
| Certification Date | 05/12/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386713972 | NPI | - | NPPES |
| 288499 | Medicaid | OR | |
| CG6801 | Other | OR | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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