Organization · Type 2 NPI

Providence Health & Services - Oregon

Clinic/Center · Medford, OR

NPI number 1093976243 Active

Practice location

1111 Crater Lake Ave
Medford, OR 97504-6241

Call (541) 732-5250 Map

Fax (541) 732-5251

Mailing address

PO Box 31001-4199
Pasadena, CA 91110-4199

Specialties and licenses

Taxonomy	Code	License
Clinic/Center Primary	261Q00000X	None listed

Clinic/Center: 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).

97 other providers at this address

Other clinic/center providers in Medford

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NPI record

NPI: 1093976243
Entity type: Organization (Type 2)
Issued: Jun 20, 2008
Last updated: May 29, 2025
Status: Active
Subpart: Yes of Providence Health & Services - Oregon

Other names

<unavail>
Providence Medford Medical Center · doing business as
Providence Palliative Care South · doing business as

Authorized official

Donald W Anderson
Assistant Secretary of Enrollments
(425) 358-9786

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1093976243

Providence Health & Services - Oregon's National Provider Identifier is 1093976243, issued on Jun 20, 2008. The primary taxonomy on file is Clinic/Center (261Q00000X), and the practice location is in Medford, OR. The record was last updated on May 29, 2025.