PROVIDENCE HEALTH & SERVICES - OREGON NPI 1124129903

NPI Information

NPI: 1124129903
Provider Name: PROVIDENCE HEALTH & SERVICES - OREGON
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
:
Address: 1321 NE 99TH AVE
SUITE 200
PORTLAND, OR
ZIP 97220
Phone: (503) 215-4250

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NPI Details

PROVIDENCE HEALTH & SERVICES - OREGON is a family medicine in Portland, 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 1124129903. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

1321 NE 99TH AVE
SUITE 200
PORTLAND, OR
ZIP 97220-439
Phone: (503) 215-4250
Fax: (503) 215-4255

The provider's authorized official is Donald W Anderson .
The authorized official title is Assistant Secretary Of Enrollments and has the following contact phone number (425) 358-9786.

The enumeration date for this NPI number is 9/26/2006 and was last updated on 6/20/2025.

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
1	261Q00000X	Clinic/Center				No
2	207Q00000X	Family Medicine				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	022844	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: 11/21/2025

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