Organization · Type 2 NPI

Providence Health & Services - Oregon

Clinic/Center · Portland, OR

NPI number 1104246008 Active

Practice location

18040 SW Lower Boones Ferry Rd, Suite 104
Portland, OR 97224-7259

Call (855) 229-6490 Map

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

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).

29 other providers at this address

Other clinic/center providers in Portland

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NPI record

NPI: 1104246008
Entity type: Organization (Type 2)
Issued: Apr 18, 2014
Last updated: Jun 20, 2025
Status: Active

Other names

<unavail>
Providence Medical Group · doing business as
Providence Health Express at Bridgeport · doing business as

Authorized official

Keenan B Freeman
CFO
(503) 893-6524

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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 1104246008

Providence Health & Services - Oregon's National Provider Identifier is 1104246008, issued on Apr 18, 2014. The primary taxonomy on file is Clinic/Center (261Q00000X), and the practice location is in Portland, OR. The record was last updated on Jun 20, 2025.