PROVIDENCE HEALTH & SERVICES OREGON NPI 1568547503

NPI Information

NPI: 1568547503
Provider Name: PROVIDENCE HEALTH & SERVICES OREGON
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
:
Address: 965 ELLENDALE DR
MEDFORD, OR
ZIP 97504
Phone: (541) 732-6000

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NPI Details

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 1568547503. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

965 ELLENDALE DR
MEDFORD, OR
ZIP 97504-215
Phone: (541) 732-6000
Fax: (541) 732-6005

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

The enumeration date for this NPI number is 10/26/2006 and was last updated on 5/12/2025.

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	Primary
1	261Q00000X	Clinic/Center		No
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
3	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	No
4	2084P0805X	Psychiatry & Neurology	Geriatric Psychiatry	No
5	207R00000X	Internal Medicine		No
6	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	288515	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: 3/30/2025

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