PROVIDENCE HEALTH & SERVICES - OREGON NPI 1053419218

NPI Information

  • NPI: 1053419218
  • Provider Name: PROVIDENCE HEALTH & SERVICES - OREGON
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: PROVIDENCE MEDICAL GROUP
  • CLIA Number: 38D0965604
  • Address: 440 NW DIVISION ST
    GRESHAM, OR
    ZIP 97030
  • Phone: (503) 215-9500

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NPI Details

PROVIDENCE HEALTH & SERVICES - OREGON is a family medicine in Gresham, OR. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PROVIDENCE HEALTH & SERVICES - OREGON NPI is 1053419218. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Medical Group.

The provider's business location address is:

440 NW DIVISION ST
GRESHAM, OR
ZIP 97030-506
Phone: (503) 215-9500
Fax: (503) 215-9525

The provider's authorized official is Donald W Anderson .
The authorized official title is Asst Sec Enroll and has the following contact phone number (425) 525-5392.

The CLIA number assigned to this NPI record is 38D0965604 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 6/19/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes
2207RE0101XInternal MedicineEndocrinology, Diabetes & MetabolismNo
3261Q00000XClinic/CenterNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1287333MEDICAIDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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