Organization · Type 2 NPI

Providence Health & Services - Oregon

Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Portland, OR

NPI number 1396019451 Active

Practice location

4805 NE Glisan St, Ste 6N50
Portland, OR 97213-2933

Call (503) 215-2300 Map

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Specialties and licenses

Taxonomy	Code	License
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician Primary	208G00000X	None listed
Clinic/Center	261Q00000X	None listed

Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician: A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of th…

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NPI record

NPI: 1396019451
Entity type: Organization (Type 2)
Issued: Mar 6, 2012
Last updated: Jun 30, 2025
Status: Active

Other names

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Providence Medical Group · doing business as
Providence Thoracic Surgery · doing business as

Authorized official

Donald Wayne Anderson
Assistant Secretary 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 1396019451

Providence Health & Services - Oregon's National Provider Identifier is 1396019451, issued on Mar 6, 2012. The primary taxonomy on file is Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (208G00000X), and the practice location is in Portland, OR. The record was last updated on Jun 30, 2025.