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PROVIDENCE HEALTH & SERVICES - OREGON NPI 1922481456


NPI Information

NPI: 1922481456
Provider Name: PROVIDENCE HEALTH & SERVICES - OREGON

Doing Business As: PMG EAGLE POINT PEDIATRICS

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
10830 HIGHWAY 62
EAGLE POINT, OR
ZIP 97524
Phone: (541) 830-4060
Get Directions

PROVIDENCE HEALTH & SERVICES - OREGON is a clinic center in Eagle Point, 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 1922481456. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Pmg Eagle Point Pediatrics.

The provider's business location address is:

10830 HIGHWAY 62
EAGLE POINT, OR
ZIP 97524-516
Phone: (541) 830-4060
Fax: (541) 830-4090

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 enumeration date for this NPI number is 7/1/2015 and was last updated on 8/10/2020.


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
12084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryNo
2261QM0855XClinic/CenterAdolescent and Children Mental HealthNo
3261Q00000XClinic/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
1500688628MEDICAIDOREGON

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

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