PROVIDENCE HEALTH & SERVICES - OREGON


Address: 920 Royal Ave, Medford, OR 97504-6169
Phone: 5417328400

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM1300X Clinic/Center
Specialization: Multi-Specialty
Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
PMG Medford Physiatry Doing Business As Name - Organization
PMG South Medford Neurology Doing Business As Name - Organization

Other Provider IDs and Locations

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

Other Data Sources

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

Office Location

Street Address 920 ROYAL AVE
City MEDFORD
State OR
Zip Code 97504-6169

Providers in the same location

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

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 261QM1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Multi-Specialty

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1457685109 University Professional Services Clinic/Center 2825 E Barnett Rd, Medford, OR 97504-8332 2009-09-29

Providers in the same taxonomy and state

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
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Competitor

Search similar providers

City MEDFORD
Zip Code 97504

Improve Information

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Dataset Information

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.

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