PROVIDENCE HEALTH & SERVICES OREGON NPI 1386713972

NPI Information

NPI: 1386713972
Provider Name: PROVIDENCE HEALTH & SERVICES OREGON

Doing Business As: PMG SOUTH MEDFORD FAMILY PRACTICE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
1698 E MCANDREWS RD
SUITE 300
MEDFORD, OR
ZIP 97504
Phone: (541) 732-7950
Get Directions

PROVIDENCE HEALTH & SERVICES OREGON is a family medicine in Medford, 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 1386713972. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Pmg South Medford Family Practice.

The provider's business location address is:

1698 E MCANDREWS RD
SUITE 300
MEDFORD, OR
ZIP 97504-589
Phone: (541) 732-7950
Fax: (541) 732-7901

The provider's authorized official is Donald Wayne Anderson .
The authorized official title is Asst Corp Secretary For Enrollments and has the following contact phone number (425) 525-5392.

The enumeration date for this NPI number is 11/7/2006 and was last updated on 4/24/2019.

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	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry			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	288499	MEDICAID	OREGON
2	CG6801	OTHER	OREGON	RAILROAD MEDICARE

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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