Providence Health & Services Oregon

NPI #1568547503 in Medford, Oregon

Provider Information

NPI Number
1568547503
Entity Type
Organization
Organization Name
Providence Health & Services Oregon
Subpart
Yes (part of a larger organization)
Parent Organization
PROVIDENCE HEALTH & SERVICES OREGON
Primary Specialty
Family Medicine
Enumeration Date
Oct 26, 2006
Last Updated
Nov 19, 2025

Practice Location

Address
965 ELLENDALE DR
State
Oregon
ZIP Code
97504-8215
Phone
(541) 732-6000

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Clinic/Center
Internal Medicine
Clinic/Center - Adolescent and Children Mental HealthAdolescent and Children Mental Health
Psychiatry & Neurology - Child & Adolescent PsychiatryChild & Adolescent Psychiatry
Psychiatry & Neurology - Geriatric PsychiatryGeriatric Psychiatry
Family Medicine

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