PROVIDENCE HEALTH & SERVICES - OREGON NPI 1093963209

NPI Information

NPI: 1093963209
Provider Name: PROVIDENCE HEALTH & SERVICES - OREGON

Doing Business As: PROVIDENCE PSYCHIATRY EAST

Classification: Clinic/Center - 261QM0850X
Entity Type: Organization

Specialization: Adult Mental Health

Address:
5251 NE GLISAN ST
BLDG A, 2ND FLOOR
PORTLAND, OR
ZIP 97213
Phone: (503) 215-4860
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PROVIDENCE HEALTH & SERVICES - OREGON is an adult mental health clinic center in Portland, OR. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. PROVIDENCE HEALTH & SERVICES - OREGON NPI is 1093963209. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Psychiatry East.

The provider's business location address is:

5251 NE GLISAN ST
BLDG A, 2ND FLOOR
PORTLAND, OR
ZIP 97213-052
Phone: (503) 215-4860

The provider's authorized official is Donald W Anderson .
The authorized official title is Dir Reimb Reg Strat/asst Sec Enroll and has the following contact phone number (425) 525-5392.

The enumeration date for this NPI number is 8/29/2008 and was last updated on 9/23/2020.

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 State	Primary
1	2084P0800X	Psychiatry & Neurology	Psychiatry	OREGON	No
2	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	OREGON	No
3	2084P0805X	Psychiatry & Neurology	Geriatric Psychiatry	OREGON	No
4	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	OREGON	No
5	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	OREGON	No
6	261QM0850X	Clinic/Center	Adult Mental Health		Yes

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
1	500611962	MEDICAID	OREGON
2	500601335	MEDICAID	OREGON

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: 4/28/2024

NPI Synchronization or Removal

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