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PROVIDENCE HEALTH & SERVICES - OREGON NPI 1235479643


NPI Information

NPI: 1235479643
Provider Name: PROVIDENCE HEALTH & SERVICES - OREGON

Doing Business As: PROVIDENCE MEDICAL GROUP SPORTS CARE

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
909 SW 18TH AVE
PORTLAND, OR
ZIP 97205
Phone: (503) 962-1946
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PROVIDENCE HEALTH & SERVICES - OREGON is a clinic center in Portland, OR. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). PROVIDENCE HEALTH & SERVICES - OREGON NPI is 1235479643. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Medical Group Sports Care.

The provider's business location address is:

909 SW 18TH AVE
PORTLAND, OR
ZIP 97205-705
Phone: (503) 962-1946
Fax: (503) 962-1925

The provider's authorized official is Donald Wayne Anderson .
The authorized official title is Asst Sec For Enrollment/dir Reimb and has the following contact phone number (425) 276-3215.

The enumeration date for this NPI number is 2/21/2013 and was last updated on 8/20/2021.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineNo
2207RS0010XInternal MedicineSports MedicineNo
3261Q00000XClinic/CenterYes

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.