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Contact Information

PROVIDENCE HEALTH & SERVICES - OREGON
4805 NE GLISAN ST STE 11N
PORTLAND, OR97213-2933
 Phone: 503-215-3053
 Fax: 503-215-3037
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Oral & Maxillofacial Surgery

204E00000X 02 Physician/General Surgery
 

Clinic/Center

261Q00000X
Indicates primary specialty

NPI Profile & details for PROVIDENCE HEALTH & SERVICES - OREGON

NPI # 1407109937
LBN Legal business name PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official DONALD ANDERSON - (ASSISTANT SECRETARY ENROLLMENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/22/2012
Last updated 03/23/2026 - About 2 months ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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