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PROVIDENCE HEALTH & SERVICES - OREGON NPI 1699870873


NPI Information

NPI: 1699870873
Provider Name: PROVIDENCE HEALTH & SERVICES - OREGON

Doing Business As: PROVIDENCE MEDICAL GROUP MILWAUKIE FAMILY MEDICINE

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 38D0967734

Address:
10330 SE 32ND AVE
SUITE 205
MILWAUKIE, OR
ZIP 97222
Phone: (503) 513-8950
Get Directions

PROVIDENCE HEALTH & SERVICES - OREGON is a clinic center in Milwaukie, OR. The provider is 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). PROVIDENCE HEALTH & SERVICES - OREGON NPI is 1699870873. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Medical Group Milwaukie Family Medicine.

The provider's business location address is:

10330 SE 32ND AVE
SUITE 205
MILWAUKIE, OR
ZIP 97222-594
Phone: (503) 513-8950
Fax: (503) 513-8951

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 38D0967734 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/13/2006 and was last updated on 9/24/2020.


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
1103T00000XPsychologistNo
2207Q00000XFamily MedicineNo
3363LF0000XNurse PractitionerFamilyNo
4261Q00000XClinic/CenterYes

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
1022861MEDICAIDOREGON

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

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