Providence Health & Services Oregon

NPI #1104097906 in Longview, Washington

Provider Information

NPI Number: 1104097906
Entity Type: Organization
Organization Name: Providence Health & Services Oregon
Subpart: Yes (part of a larger organization)
Parent Organization: PROVIDENCE HEALTH & SERVICES - OREGON
Primary Specialty: Pediatrics
Enumeration Date: Mar 19, 2008
Last Updated: Jun 20, 2025

Practice Location

Address: 971 11TH AVE
City: Longview
State: Washington
ZIP Code: 98632-2503
Phone: (360) 577-1771

Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title: ASSISTANT SECRETARY OF ENROLLMENTS
Phone: (425) 358-9786

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X
Pediatrics	208000000X	Primary

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