Providence Health & Services | |
1510 Division St Ste 200 Oregon City OR 97045-1599 | |
(503) 650-6880 | |
(503) 650-6888 |
Full Name | Providence Health & Services |
---|---|
Speciality | Internal Medicine |
Location | 1510 Division St Ste 200, Oregon City, Oregon |
Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC ENROLLMENT) |
Authorized Official Contact | 4253589786 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Providence Health & Services Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Health & Services 1510 Division St Ste 200 Oregon City OR 97045-1599 Ph: (503) 650-6880 |
NPI Number | 1154539203 |
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Provider Enumeration Date | 05/21/2007 |
Last Update Date | 05/05/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154539203 | NPI | - | NPPES |
067983 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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