PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1245567817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245567817 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP CANBY IMMEDIATE CARE |
| Practice Address |
200 S Hazel Dell Way Canby OR 97013-7829 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032639500 |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2013-09-25 |
| Authorized Official Name | KEENAN B FREEMAN (CFO) |
| Authorized Official Telephone | 5038936524 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500617241 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Medical Group Canby Immediate Care | 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 |
200 S HAZEL DELL WAY |
| City | CANBY |
| State | OR |
| Zip Code | 97013-7829 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164499463 | Sandra Leigh Kosik | Physician Assistant | 200 S Hazel Dell Way, Canby, OR 97013-7829 | 2006-03-06 |
| 1336520550 | Kathlyn A Khoukaz | Psychologist | 200 S Hazel Dell Way, Canby, OR 97013-7829 | 2015-06-12 |
| 1184977233 | Providence Health & Services - Oregon | Family Medicine | 200 S Hazel Dell Way, Canby, OR 97013-7829 | 2012-10-25 |
| 1972867091 | Melissa M Calhoun | Family Medicine | 200 S Hazel Dell Way, Canby, OR 97013-7829 | 2012-07-03 |
| 1710185087 | Christopher M Berberian | Emergency Medicine | 200 S Hazel Dell Way, Canby, OR 97013-7829 | 2007-07-06 |
| 1033278866 | Karen Gaye Harris | Family Medicine | 200 S Hazel Dell Way, Canby, OR 97013-7829 | 2006-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639634314 | Clackamas County School District 86 | Local Education Agency (LEA) | 1130 S Ivy Street, Canby, OR 97013 | 2019-02-06 |
| 1669924502 | Brigid Marie-crotty Piccolotti | Speech-Language Pathologist | 344 N Holly St, Canby, OR 97013 | 2016-10-26 |
| 1497150247 | Speech With Sarah - LLC | Speech-Language Pathologist | 366 N. Holly St., Canby, OR 97013 | 2014-10-22 |
| 1164838116 | Annaliese Dianna Ellsworth | Social Worker | 550 Nw 3rd Ave Ste Bandc, Canby, OR 97013 | 2014-07-09 |
| 1639500804 | Alison Johnson | Social Worker | 11303 S Mulino Rd, Canby, OR 97013 | 2013-12-12 |
| 1184975260 | Tara Marie Mcgarry | Psychologist | 1433 Se 1st Ave, Canby, OR 97013 | 2012-09-28 |
| 1235488842 | Natalie Jackson Ballas | Dentist | 300 N Holly Street, Canby, OR 97013 | 2012-08-29 |
| 1699021667 | Canby Clinic | Naturopath | 452 Nw 1st Avenue, Canby, OR 97013 | 2012-07-27 |
| 1518231950 | Kyle Greer | Pharmacist | 1401 Se First, Canby, OR 97013 | 2012-03-02 |
| 1912284027 | Julie Michelle Francis | Counselor | 1655 S. Elm St #508, Canby, OR 97013 | 2011-11-03 |
| Find all providers in zip 97013 | ||||
| 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 |
|---|---|---|---|---|
| 1326187261 | Lake Health District | Clinic/Center | 670 County Rd 83, Canby, CA 96015 | 2007-02-06 |
| 1376164749 | Last Frontier Healthcare District | Clinic/Center | 670 County Road 83, Canby, CA 96015-9722 | 2020-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932715935 | J.w. Smith, D.c., LLC | Clinic/Center | 4747 S 6th St Ste 2, Klamath Falls, OR 97603-4993 | 2020-09-16 |
| 1427662204 | Edmund H. Torkelson Do, PC | Clinic/Center | 1960 Nw 167th Pl Ste 204, Beaverton, OR 97006-4804 | 2020-08-31 |
| 1134746589 | Redmond Veterinary Clinic PC | Clinic/Center | 1785 Nw 6th St, Redmond, OR 97756-1204 | 2020-07-01 |
| 1801413240 | Gfm LLC | Clinic/Center | 1235 Se Division St Ste 114, Portland, OR 97202-1042 | 2020-07-01 |
| 1184240277 | Evans & Company Healthcare PC | Clinic/Center | 2330 Morada Ln, Ashland, OR 97520-3641 | 2020-06-24 |
| 1427674324 | Northwest Pain Institute | Clinic/Center | 2005 Cedar St, Forest Grove, OR 97116-1701 | 2020-06-17 |
| 1275168759 | Metatron Health LLC | Clinic/Center | 6464 Sw Borland Rd Ste C3, Tualatin, OR 97062-8856 | 2020-03-05 |
| 1427680057 | Ortc, LLC | Clinic/Center | 750 Biddle Rd Ste 102, Medford, OR 97504-6178 | 2020-02-11 |
| 1134750037 | Legacy Good Samaritan Hospital and Medical Center | Clinic/Center | 1040 Nw 22nd Ave Ste 250, Portland, OR 97210-3057 | 2020-01-29 |
| 1861038382 | Clackamas County | Clinic/Center | 2051 Kaen Rd Ste 210, Oregon City, OR 97045-4035 | 2019-11-19 |
| 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.