PROVIDENCE HEALTH & SERVICES OREGON (NPI# 1003319724) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003319724 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES OREGON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP |
| Practice Address |
5211 Ne Glisan St Bldg C Portland OR 97213-3052 |
| Practice Telephone | 5032156628 |
| Practice Fax Number | 5032156240 |
| Mailing Telephone | 5032156628 |
| Mailing Fax Number | 5032156240 |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2018-03-09 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASST SECRETARY ENROLLMENT) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| PROVIDENCE MEDICAL GROUP | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518425693 | Providence Health & Services Oregon | Durable Medical Equipment & Medical Supplies | 2296 Nw Kings Blvd Ste 101, Corvallis, OR 97330-3871 | 2019-03-07 |
| 1841756764 | Providence Health & Services Oregon | Family Medicine | 171 N Larch St Ste 16, Cannon Beach, OR 97110-3103 | 2019-02-15 |
| 1346751443 | Providence Health & Services Oregon | General Practice | 4400 Ne Halsey St, Pop 2, 3rd Floor, Portland, OR 97213-1545 | 2017-10-16 |
| 1922453943 | Providence Health & Services Oregon | Assisted Living Facility | 1550 Brookside Dr, Hood River, OR 97031-8553 | 2016-04-27 |
| 1649541020 | Providence Health & Services Oregon | Clinic/Center | 211 Ne Skyline Dr, White Salmon, WA 98672 | 2012-01-18 |
| 1922330828 | Providence Health & Services Oregon | Pharmacy | 18040 Sw Lower Boones Ferry Rd Ste 104, Tigard, OR 97224-7259 | 2010-02-03 |
| 1801010004 | Providence Health & Services Oregon | Internal Medicine | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2007-04-12 |
| 1487746491 | Providence Health & Services Oregon | Home Health | 2033 Commerce Dr, Medford, OR 97504-9744 | 2006-09-28 |
| 1831196302 | Providence Health & Services Oregon | Home Health | 570 S Main Street, Mount Angel, OR 97362-9540 | 2005-06-30 |
| 1972039170 | Providence Health & Services Oregon | Clinic/Center | 171 S Highway 101, Warrenton, OR 97146 | 2017-05-08 |
| Street Address |
5211 NE GLISAN ST BLDG C |
| City | PORTLAND |
| State | OR |
| Zip Code | 97213-3052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205029345 | Christiann Michelle Collins | Dietitian, Registered | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2007-08-22 |
| 1831650100 | Kaile Hannah Zaretsky | Nurse Practitioner | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2019-03-28 |
| 1912475948 | Megan Lindley | Dietitian, Registered | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-11-07 |
| 1033600911 | Ellen Lea Postel | Health Educator | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-05-25 |
| 1578061362 | Deborah Best | Community Health Worker | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-01-26 |
| 1760980874 | Suzanne Black | Dietitian, Registered | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-01-24 |
| 1275041436 | Fred Mclane Bruderlin Jr. | Community Health Worker | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-01-22 |
| 1184132565 | Yemaly Alexander | Community Health Worker | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-01-19 |
| 1912415381 | Adriana Guadalupe Gonzalez Mejia | Community Health Worker | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-01-18 |
| 1932617537 | Devita Lee | Community Health Worker | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-01-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831715176 | Darnell Jackie Strong | Social Worker | 435 Ne 78th Ave 'strong Counseling Services', Portland, OR 97213 | 2020-06-23 |
| 1336775907 | Redpoint Physical Therapy and Performance LLC | Physical Therapist | 4200 Ne Flanders St Unit B, Portland, OR 97213 | 2020-03-16 |
| 1801431218 | Denise Dorgan-miller | Occupational Therapy Assistant | Providence Elder Place, 4400 Ne Halsey Suite 200, Portland, OR 97213 | 2019-11-08 |
| 1619435617 | Aspiration of Character Counseling Services, LLC | Counselor | 4424 Ne Glisan St, The Li Wellness Building, Second Floor, Portland, OR 97213 | 2019-03-08 |
| 1578049631 | Credena Health LLC | Pharmacy | 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 | 2018-07-12 |
| 1023507795 | Karissa Lynn Schwartz | Speech-Language Pathologist | Providence Portland Medical Center, 4805 Ne Glisan St, Portland, OR 97213 | 2018-05-08 |
| 1861944506 | James Livingston Taylor | Chiropractor | 5212 Ne Sacremento St., Portland, OR 97213 | 2016-10-28 |
| 1962958520 | Caitlin Turner | Massage Therapist | 4317 Ne Tillamook St., Portland, OR 97213 | 2016-09-01 |
| 1326407008 | Julianna Vermeys | Counselor | 4605 Ne Fremont St., 209a, Portland, OR 97213 | 2016-02-23 |
| 1881059822 | Thomas Michael Barrett | Counselor | 5228 Ne Hoyt St. Bldg. B, Portland, OR 97213 | 2015-12-17 |
| Find all providers in zip 97213 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801413240 | Gfm LLC | Clinic/Center | 1235 Se Division St Ste 114, Portland, OR 97202-1042 | 2020-07-01 |
| 1134750037 | Legacy Good Samaritan Hospital and Medical Center | Clinic/Center | 1040 Nw 22nd Ave Ste 250, Portland, OR 97210-3057 | 2020-01-29 |
| 1679030290 | Yoana Kanev | Clinic/Center | 3701 Sw Condor Ave Apt C1, Portland, OR 97239-4158 | 2019-03-01 |
| 1841760584 | Orthopedic Needle LLC | Clinic/Center | 328 Ne Failing St Ste C, Portland, OR 97212-1157 | 2018-11-26 |
| 1073081881 | Sober Living Oregon Recovery Center | Clinic/Center | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2018-11-09 |
| 1366933830 | Dr Frances V Verzosa Md PC | Clinic/Center | 12770 Se Stark St Bldg C, Portland, OR 97233-1539 | 2018-05-21 |
| 1023520814 | Concordia Wellness, LLC | Clinic/Center | 3014 Ne Killingsworth St, Portland, OR 97211-6814 | 2017-11-01 |
| 1114443124 | Zephyr Acupuncture and Bodywork, LLC | Clinic/Center | 4313 Ne Tillamook St, Portland, OR 97213-1315 | 2017-08-22 |
| 1164952495 | Earth Source Medicine | Clinic/Center | 2207 Ne Broadway St Ste 200, Portland, OR 97232-1791 | 2017-06-19 |
| 1902353873 | Siesta Acupuncture LLC | Clinic/Center | 2818 Se 70th Ave, Portland, OR 97206-1117 | 2016-09-08 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.