| Providence Health & Services Oregon | |
|
4400 Ne Halsey St, Bldg 2 Ste 599 Portland OR 97213-1545 | |
| (503) 215-3300 | |
| Not Available |
| Full Name | Providence Health & Services Oregon |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4400 Ne Halsey St, Bldg 2, Portland, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY OF ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health & Services Oregon Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Health & Services Oregon 4400 Ne Halsey St, Bldg 2 Ste 599 Portland OR 97213-1545 Ph: (503) 215-3300 |
| NPI Number | 1760177737 |
|---|---|
| Provider Enumeration Date | 04/06/2023 |
| Last Update Date | 04/06/2023 |
| Certification Date | 04/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760177737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
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