Providence Medical Group

LBN: Providence Health & Services - Oregon
Providence Medical Group is an health care organization with primary practice located at 4004 Kruse Way Pl Ste 300 , Lake Oswego OR 97035-2479. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Ambulatory Health Care Facilities / Clinic/Center. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. Providence Health & Services - Oregon can be contacted via phone (503) 216-1500, or through Anderson, Donald W via phone (425) 525-5392.

Contact Information

Primary practice address
4004 Kruse Way Pl Ste 300 Lake Oswego OR 97035-2479
Phone: (503) 216-1500
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Anderson, Donald W
Phone: (425) 525-5392

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X
Ambulatory Health Care Facilities / Clinic/Center 261Q00000X

Profile Details

NPI number 1205937273
LBN Legal business name Providence Health & Services - Oregon
DBA Doing business as Providence Medical Group
Authorized official Anderson, Donald W
Entity Organization
Organization subpart 1 No
Enumeration date Sep 25th, 2006
Last updated Jun 10th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205937273 NPPES
Oregon MEDICAID 241291

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