Providence Health & Services Oregon
Internal Medicine, Endocrinology, Diabetes & Metabolism in Medford, OR. Organization (NPI-2).
NPI number1982146064
StatusActive
Last updated in NPPESNov 19, 2025
Details
- NPI
- 1982146064
- Entity type
- Organization (NPI-2)
- Legal business name
- Providence Health & Services Oregon
- Organization subpart
- No
- Enumeration date
- Nov 7, 2016
- Certification date
- Nov 19, 2025
- Last updated
- Nov 19, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RE0101X | Internal Medicine, Endocrinology, Diabetes & Metabolism | – | – | Yes |
| 261Q00000X | Clinic/Center | – | – |
Other names
- Providence Medical Group South (Doing Business As)
- Pmg Gastroenterology (Doing Business As)
Practice location
1698 E McAndrews Rd Ste 400Medford, OR 97504-5590
Phone 541-732-8500 · Fax 541-732-8501
Mailing address
Po Box 31001 - 4180Pasadena, CA 91110-4180
Phone 541-732-8500
Authorized official
Donald Wayne Anderson
Assistant Secretary Enrollments
4253589786
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