PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1063705887) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1063705887 |
Entity Type | Organization |
Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
Other Organization Name | PMG MEDFORD PHYSIATRY |
Practice Address |
920 Royal Ave Medford OR 97504-6169 |
Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
Practice Telephone | 5417328400 |
Practice Fax Number | 5417328401 |
Mailing Telephone | 5032156494 |
Enumeration Date | 2011-05-26 |
Last Update Date | 2020-10-01 |
Authorized Official Name | MR. DONALD W ANDERSON JR. (DIR REIMB REG STRAT/ASST SEC ENROLL) |
Authorized Official Telephone | 4255255392 |
Is Organization Subpart | Y |
Parent Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
PMG Medford Physiatry | Doing Business As Name - Organization |
PMG South Medford Neurology | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922481456 | Providence Health & Services - Oregon | Psychiatry & Neurology | 10830 Highway 62, Eagle Point, OR 97524-9516 | 2015-07-01 |
1023440435 | Providence Health & Services - Oregon | General Acute Care Hospital | 11445 Se Moon Dust Ct, Happy Valley, OR 97086-8033 | 2013-08-08 |
1568793313 | Providence Health & Services - Oregon | Clinic/Center | 17550 Provost St Ste 201, Lake Oswego, OR 97034-5199 | 2010-01-19 |
1508015348 | Providence Health & Services - Oregon | Clinic/Center | 16180 Se Sunnyside Road, Suite 102, Happy Valley, OR 97015-6302 | 2008-09-17 |
1114085545 | Providence Health & Services - Oregon | Internal Medicine | 1314 E Sherman St, Newberg, OR 97132-1842 | 2006-12-05 |
1629146121 | Providence Health & Services - Oregon | Otolaryngology | 310 Villa Rd, Suite 104, Newberg, OR 97132-1886 | 2006-12-01 |
1992882500 | Providence Health & Services - Oregon | Clinic/Center | 205 N Phoenix Rd, Suite A, Phoenix, OR 97535-9104 | 2006-11-01 |
1013018175 | Providence Health & Services - Oregon | Clinic/Center | 510 Bridge St, Vernonia, OR 97064-1218 | 2006-09-25 |
1447799523 | Providence Health & Services - Oregon | Clinic/Center | 1698 E Mcandrews Rd Ste 170, Medford, OR 97504-5590 | 2017-02-22 |
1063963106 | Providence Health & Services - Oregon | Clinic/Center | 1698 E Mcandrews Rd, Ste 300, Medford, OR 97504-5589 | 2016-10-24 |
Entity Type | Entity Name | Entity Address |
---|---|---|
Colorado Business Entities | Providence Health & Services - Oregon | 1801 Lind Avenue, Sw, Renton, WA 98057-9016 |
Oregon Corporations, Companies and Business Names | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave Sw #9016, Renton, WA 98057 |
System for Award Management (SAM) Entities | PROVIDENCE HEALTH & SERVICES - OREGON | 4400 Ne Halsey St Bldg 2 Ste 690, Portland, OR 97213-1545 |
Iowa Business Entities | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave. Sw, Renton, WA 98057 |
Washington State Corporations | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave Sw # 9016, Renton, WA 98057 |
Street Address |
920 ROYAL AVE |
City | MEDFORD |
State | OR |
Zip Code | 97504-6169 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114927753 | Michael Steven Narus | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2005-07-26 |
1881006997 | Erin Marie Dittmer | Nurse Practitioner | 920 Royal Ave, Medford, OR 97504-6169 | 2014-05-22 |
1720424591 | Minji Kim | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2013-05-20 |
1790038495 | Jennifer Katharine Boudreaux | Nurse Practitioner | 920 Royal Ave, Medford, OR 97504-6169 | 2012-10-18 |
1578821013 | Sabre Amira Patton-fee | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504 | 2012-05-02 |
1689955536 | Pawani Sachar | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2011-09-06 |
1275821746 | Oregon Ear Nose and Throat Surgery | Clinic/Center | 920 Royal Ave, Medford, OR 97504-6169 | 2011-07-18 |
1639279243 | Donald M Olson | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2006-09-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
Find all providers in zip 97504 |
Taxonomy Code | 261QM1300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Multi-Specialty |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457685109 | University Professional Services | Clinic/Center | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2009-09-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1972113306 | Harney District Hospital | Clinic/Center | 271 N Egan Ave, Burns, OR 97720-1733 | 2020-07-31 |
1922583616 | Wvp Medical Group, LLC | Clinic/Center | 2995 Ryan Dr Se Ste 200, Salem, OR 97301-5157 | 2018-09-27 |
1588153076 | Kaiser Foundation Health Plan of The Northwest | Clinic/Center | 3060 Se Hawthorne Blvd, Portland, OR 97214-4121 | 2018-05-09 |
1942718457 | Mid-columbia Medical Center | Clinic/Center | 1815 E 19th St Ste 1, The Dalles, OR 97058-3385 | 2018-01-18 |
1255844908 | Affordable Health Care & Chiropractic Inc | Clinic/Center | 2130 Se 96th Ave, Portland, OR 97216-2603 | 2017-11-15 |
1710402532 | Edge Medical Services Inc | Clinic/Center | 19800 Village Office Ct Ste 15, Bend, OR 97702-1872 | 2017-08-14 |
1699167239 | Community Wellness Center | Clinic/Center | 1995 8th Ave, West Linn, OR 97068-4604 | 2015-02-19 |
1730518754 | Rebecca Berzow Nd | Clinic/Center | 15455 Nw Greenbrier Pkwy Ste 100, Beaverton, OR 97006-7357 | 2013-11-12 |
1659605707 | University Professional Services | Clinic/Center | 2858 Eberlein Ave, Klamath Falls, OR 97603-4402 | 2009-09-22 |
1770769424 | Adapt Training | Clinic/Center | 9923 Sw Arctic Dr, Beaverton, OR 97005-4194 | 2008-01-11 |
Find all providers with the same taxonomy |
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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.