Providence Health & Services - Oregon
Obstetrics & Gynecology, Gynecology in Portland, OR. Organization (NPI-2).
NPI number1083059778
StatusActive
Last updated in NPPESJul 4, 2025
Details
- NPI
- 1083059778
- Entity type
- Organization (NPI-2)
- Legal business name
- Providence Health & Services - Oregon
- Organization subpart
- No
- Enumeration date
- May 8, 2013
- Certification date
- Jul 4, 2025
- Last updated
- Jul 4, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207VG0400X | Obstetrics & Gynecology, Gynecology | – | – | Yes |
| 261Q00000X | Clinic/Center | – | – |
Other names
- Providence Gynecology Clinic West (Doing Business As)
- Providence Medical Group (Doing Business As)
Practice location
9427 Sw Barnes RdSuite 599
Portland, OR 97225-6652
Phone 503-216-0490 · Fax 503-216-0495
Mailing address
Po Box 31001 - 4180Pasadena, CA 91110-4180
Authorized official
Donald Wayne Anderson
Assistant Secretary Enrollments
4253589786
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