Organization · Type 2 NPI

Providence Health & Services Oregon

Family Medicine Physician · Medford, OR

NPI number 1568547503 Active

Practice location

965 Ellendale Dr
Medford, OR 97504-8215

Call (541) 732-6000 Map

Fax (541) 732-6005

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	None listed
Internal Medicine Physician	207R00000X	None listed
Child & Adolescent Psychiatry Physician	2084P0804X	None listed
Geriatric Psychiatry Physician	2084P0805X	None listed
Clinic/Center	261Q00000X	None listed
Adolescent and Children Mental Health Clinic/Center	261QM0855X	None listed

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

24 other providers at this address

Other family medicine physician providers in Medford

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NPI record

NPI: 1568547503
Entity type: Organization (Type 2)
Issued: Oct 26, 2006
Last updated: Nov 19, 2025
Status: Active
Subpart: Yes of Providence Health & Services Oregon

Other names

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Providence Medical Group South · 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 1568547503

Providence Health & Services Oregon's National Provider Identifier is 1568547503, issued on Oct 26, 2006. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Medford, OR. The record was last updated on Nov 19, 2025.