PROVIDENCE HEALTH & SERVICES - OREGON NPI 1174969778

NPI Information

NPI: 1174969778
Provider Name: PROVIDENCE HEALTH & SERVICES - OREGON

Doing Business As: PMG ASHLAND

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 38D2070918

Address:
1661 HIGHWAY 99 N
BUILDING A, SUITE 100
ASHLAND, OR
ZIP 97520
Phone: (541) 732-8300
Get Directions

PROVIDENCE HEALTH & SERVICES - OREGON is a multi-specialty clinic center in Ashland, OR. PROVIDENCE HEALTH & SERVICES - OREGON NPI is 1174969778. The provider is registered as an organization entity type.
The provider Is Doing Business As Pmg Ashland.

The provider's business location address is:

1661 HIGHWAY 99 N
BUILDING A, SUITE 100
ASHLAND, OR
ZIP 97520-900
Phone: (541) 732-8300
Fax: (541) 732-8301

The provider's authorized official is Donald W Anderson .
The authorized official title is Dir Reimb Reg Strat/asst Sec Enroll and has the following contact phone number (425) 525-5392.

The CLIA number assigned to this NPI record is 38D2070918 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2013 and was last updated on 12/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500661228	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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