PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1093963209) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093963209 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PROVIDENCE PSYCHIATRY EAST |
| Practice Address |
5251 Ne Glisan St Bldg A, 2nd Floor Portland OR 97213-3052 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032154860 |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2020-09-23 |
| Authorized Official Name | MR. DONALD W ANDERSON JR. (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
OR | Allopathic & Osteopathic Physicians | |
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
OR | Allopathic & Osteopathic Physicians | |
| N | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
OR | Allopathic & Osteopathic Physicians | |
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
OR | Ambulatory Health Care Facilities | |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
OR | Physician Assistants & Advanced Practice Nursing Providers | |
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500611962 | 05 | |
| OR | 500601335 | 05 |
| Other Name | Type Code |
|---|---|
| PROVIDENCE PSYCHIATRY EAST | 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 |
5251 NE GLISAN ST BLDG A, 2ND FLOOR |
| City | PORTLAND |
| State | OR |
| Zip Code | 97213-3052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831157437 | Carrie E Milligan | Internal Medicine | 5251 Ne Glisan St, 2nd Floor, Portland, OR 97213-3052 | 2006-05-03 |
| 1548527492 | Laura Anne Brogoch | Psychiatry & Neurology | 5251 Ne Glisan St, Bldg A, 2nd Floor, Portland, OR 97213-3052 | 2012-04-17 |
| 1821226713 | Brian Denney Becker Broncheau | Psychiatry & Neurology | 5251 Ne Glisan St, Bldg A, 2nd Floor, Portland, OR 97213-3052 | 2009-06-30 |
| 1063675916 | Michael John Zalanka | Internal Medicine | 5251 Ne Glisan St, 2nd Floor, Portland, OR 97213-3052 | 2008-07-09 |
| 1306047576 | James A Peykanu | Internal Medicine | 5251 Ne Glisan St, 2nd Floor, Portland, OR 97213-3052 | 2007-05-29 |
| 1518095728 | Robert O Olsen Jr. | Internal Medicine | 5251 Ne Glisan St, 2nd Floor, Portland, OR 97213-3052 | 2007-03-01 |
| 1770651200 | Palaniappan Chidambaram | Internal Medicine | 5251 Ne Glisan St, Bldg A, 2nd Floor, Portland, OR 97213-3052 | 2006-12-01 |
| 1144309204 | Karen A Vernier | Internal Medicine | 5251 Ne Glisan St, 2nd Floor, Portland, OR 97213-3052 | 2006-11-02 |
| 1831290469 | Anne Barnes | Psychiatry & Neurology | 5251 Ne Glisan St, Bldg A, 2nd Floor, Portland, OR 97213-3052 | 2006-09-26 |
| 1821009606 | Sharon J. Hammond | Registered Nurse | 5251 Ne Glisan St, Bldg A, 2nd Floor, Portland, OR 97213-3052 | 2006-08-10 |
| 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 | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851999841 | Laura Gottfried Lcsw Inc. | Clinic/Center | 145 Newbury St Ste 2, Portland, ME 04101-4261 | 2020-10-13 |
| 1265039564 | Embodied Life Therapy Center LLC | Clinic/Center | 6906 N Richards St, Portland, OR 97203-6138 | 2020-10-08 |
| 1720685696 | Pragmatic Healing LLC | Clinic/Center | 3930 Sw Plum St Apt 1, Portland, OR 97219-6046 | 2020-10-05 |
| 1467086215 | Deborah Ann Jewell | Clinic/Center | 5627 Ne Simpson St, Portland, OR 97218-2329 | 2020-03-01 |
| 1174023808 | Blake Locher Counseling, LLC | Clinic/Center | 1020 Sw Taylor St Ste 449, Portland, OR 97205-2556 | 2018-02-19 |
| 1134633100 | Paul Myers, Ph.d., LLC | Clinic/Center | 5441 Sw Macadam Ave Ste 104, Portland, OR 97239-3821 | 2017-11-28 |
| 1891206785 | Janz Consulting | Clinic/Center | 1020 Sw Taylor St Ste 635, Portland, OR 97205-2524 | 2017-10-18 |
| 1467979914 | Awakened Heart Pdx, LLC | Clinic/Center | 322 Nw 5th Ave Ste 308, Portland, OR 97209-3851 | 2017-08-25 |
| 1669739389 | Casco Bay Medical Pllc | Clinic/Center | 371 Fore St, 201, Portland, ME 04101-5112 | 2012-04-19 |
| 1306132220 | Patricia Camplair, Phd PC | Clinic/Center | 1020 Sw Taylor St Ste 720, Portland, OR 97205-2512 | 2011-06-20 |
| 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.