Organization · Type 2 NPI

Providence Health & Services - Oregon

Clinic/Center · Phoenix, OR

NPI number 1992882500 Active

Practice location

205 N Phoenix Rd, Suite A
Phoenix, OR 97535-9104

Call (541) 732-5760 Map

Fax (541) 732-3406

Mailing address

PO Box 3158
Portland, OR 97208-3158

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).

NPI record

NPI: 1992882500
Entity type: Organization (Type 2)
Issued: Nov 1, 2006
Last updated: Nov 19, 2025
Status: Active
Subpart: Yes of Providence Health & Services - Oregon

Other names

<unavail>
Providence Medical Group South · doing business as

Authorized official

Donald Wayne Anderson
Asst Secretary for Enrollment
(425) 525-5392

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 1992882500

Providence Health & Services - Oregon's National Provider Identifier is 1992882500, issued on Nov 1, 2006. The primary taxonomy on file is Clinic/Center (261Q00000X), and the practice location is in Phoenix, OR. The record was last updated on Nov 19, 2025.