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PROVIDENCE HEALTH & SERVICES - OREGON NPI 1679678866


NPI Information

NPI: 1679678866
Provider Name: PROVIDENCE HEALTH & SERVICES - OREGON

Doing Business As: PROVIDENCE MEDICAL GROUP SOUTHEAST FAMILY MEDICINE

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 38D0924876

Address:
4104 SE 82ND AVE
SUITE 250
PORTLAND, OR
ZIP 97266
Phone: (503) 215-9850
Get Directions

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 1679678866. The provider is registered as an organization entity type.
The provider Is Doing Business As Providence Medical Group Southeast Family Medicine.

The provider's business location address is:

4104 SE 82ND AVE
SUITE 250
PORTLAND, OR
ZIP 97266-954
Phone: (503) 215-9850
Fax: (503) 215-9855

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 CLIA number assigned to this NPI record is 38D0924876 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/13/2006 and was last updated on 9/24/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1022860MEDICAIDOREGON

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.