| Providence Medical Group South | |
|
870 S Front St Suite 200 Central Point OR 97502-2779 | |
| (541) 732-8000 | |
| (541) 732-3404 |
| Full Name | Providence Medical Group South |
|---|---|
| Speciality | Internal Medicine |
| Location | 870 S Front St, Central Point, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY ENROLLMENTS) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group South Po Box 31001 - 4180 Pasadena CA 91110-4180 Ph: (503) 215-6494 | Providence Medical Group South 870 S Front St Suite 200 Central Point OR 97502-2779 Ph: (541) 732-8000 |
| NPI Number | 1609951649 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 11/19/2025 |
| Certification Date | 11/19/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609951649 | NPI | - | NPPES |
| 288507 | Medicaid | OR | |
| CG6801 | Other | OR | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Secondary |
| 207R00000X | Internal Medicine | (NU) | Primary |
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