| Providence Medical Group | |
|
1500 Division St Oregon City OR 97045-1527 | |
| (503) 216-4329 | |
| Not Available |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1500 Division St, Oregon City, Oregon |
| Authorized Official Name and Position | Donald W Anderson (ASST SEC FOR ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Medical Group 1500 Division St Oregon City OR 97045-1527 Ph: (503) 216-4329 |
| NPI Number | 1396067773 |
|---|---|
| Provider Enumeration Date | 02/25/2010 |
| Last Update Date | 06/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396067773 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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