| Providence Health & Services - Oregon | |
|
1815 E 19th St Suite 1 The Dalles OR 97058-3385 | |
| (541) 298-5563 | |
| Not Available |
| Full Name | Providence Health & Services - Oregon |
|---|---|
| Speciality | Otolaryngology |
| Location | 1815 E 19th St, The Dalles, Oregon |
| Authorized Official Name and Position | Donald W Anderson (ASSISTANT SECRETARY OF ENROLLMENTS) |
| 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 31001-4180 Pasadena CA 91110-4118 Ph: () - | Providence Health & Services - Oregon 1815 E 19th St Suite 1 The Dalles OR 97058-3385 Ph: (541) 298-5563 |
| NPI Number | 1083963573 |
|---|---|
| Provider Enumeration Date | 08/30/2012 |
| Last Update Date | 06/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083963573 | NPI | - | NPPES |
| 500650976 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 207Y00000X | Otolaryngology | (* (Not Available)) | Primary |
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