Organization · Type 2 NPI

Providence Health & Services - Oregon

Cardiovascular Disease Physician · Ilwaco, WA

NPI number 1235595299 Active

Practice location

174 1st Ave N
Ilwaco, WA 98624-9137

Call (503) 717-7850 Map

Fax (503) 216-0775

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Specialties and licenses

Taxonomy	Code	License
Cardiovascular Disease Physician Primary	207RC0000X	None listed
Clinic/Center	261Q00000X	None listed

Cardiovascular Disease Physician: An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

14 other providers at this address

NPI record

NPI: 1235595299
Entity type: Organization (Type 2)
Issued: Jan 6, 2016
Last updated: Jul 4, 2025
Status: Active

Other names

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Providence Medical Group · doing business as
Providence ST Vincent Heart Care Clinic Ilwaco · doing business as

Authorized official

Donald Wayne Anderson
Assistant Secreatry for Enrollment
(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 1235595299

Providence Health & Services - Oregon's National Provider Identifier is 1235595299, issued on Jan 6, 2016. The primary taxonomy on file is Cardiovascular Disease Physician (207RC0000X), and the practice location is in Ilwaco, WA. The record was last updated on Jul 4, 2025.