Providence Medical Group
LBN: Providence Health & Services - Oregon
Providence Medical Group is an health care organization with primary practice located at 4104 Se 82Nd Ave Suite 250, Portland OR 97266-2954. The organization recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Allopathic & Osteopathic Physicians / Family Medicine, Ambulatory Health Care Facilities / Clinic/Center. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Providence Health & Services - Oregon can be contacted via phone (503) 215-9850, or through Anderson, Donald W via phone (425) 525-5392.
Contact Information
Primary practice address
4104 Se 82Nd Ave Suite 250
Portland OR 97266-2954
Phone: (503) 215-9850
Fax: (503) 215-9855
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | ||
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ||
| Ambulatory Health Care Facilities / Clinic/Center | 261Q00000X |
Profile Details
| NPI number | 1679678866 |
|---|---|
| LBN Legal business name | Providence Health & Services - Oregon |
| DBA Doing business as | Providence Medical Group |
| Authorized official | Anderson, Donald W |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 13th, 2006 |
| Last updated | Jun 13th, 2024 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679678866 | NPPES |
| Oregon | MEDICAID | 022860 |
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