Organization · Type 2 NPI

Providence Health & Services - Oregon

Family Medicine Physician · Eagle Point, OR

NPI number 1992031595 Active

Practice location

1332 S Shasta Ave, Suite A
Eagle Point, OR 97524-8623

Call (541) 826-8160 Map

Fax (541) 826-8197

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	None listed
Pediatrics Physician	208000000X	None listed
Child & Adolescent Psychiatry Physician	2084P0804X	None listed
Geriatric Psychiatry Physician	2084P0805X	None listed
Multi-Specialty Clinic/Center	261QM1300X	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.

2 other providers at this address

NPI record

NPI: 1992031595
Entity type: Organization (Type 2)
Issued: Nov 2, 2009
Last updated: Nov 19, 2025
Status: Active
Subpart: Yes of Providence Health & Services - Oregon

Other names

<unavail>
PMG South Eagle Point · doing business as
PMG South Eagle Point · doing business as
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 1992031595

Providence Health & Services - Oregon's National Provider Identifier is 1992031595, issued on Nov 2, 2009. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Eagle Point, OR. The record was last updated on Nov 19, 2025.