Provider Demographics
NPI:1255429338
Name:PROVIDENCE HEALTH & SERVICES OREGON
Entity type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES OREGON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY ENROLLMENTS
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-358-9786
Mailing Address - Street 1:PO BOX 31001-4199
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-4199
Mailing Address - Country:US
Mailing Address - Phone:503-451-3000
Mailing Address - Fax:503-215-0290
Practice Address - Street 1:810 12TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1587
Practice Address - Country:US
Practice Address - Phone:503-451-3000
Practice Address - Fax:503-215-0290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HEALTH & SERVICES OREGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3300415OtherWASHINGTON MEDICAID
ORCH9950OtherRAILROAD MEDICARE
OR210241Medicaid
OR5411OtherWA DEPT OF LABOR CLINIC
OR804295000OtherREGENCE CLINIC NUMBER
OR330045000001OtherPROVIDENCE HEALTH PLAN
OR5982OtherWA DEPT OF LABOR HOSPITAL
OR138000604OtherREGENCE HOSPITAL NUMBER
OR195086600OtherUS DEPT OF LABOR WC
OR227600OtherMEDICAID CLINIC OUTPT
OR381318Medicare Oscar/Certification
OR138000604OtherREGENCE HOSPITAL NUMBER