PROVIDENCE HEALTH & SERVICES OREGON (NPI# 1316197692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316197692 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES OREGON |
| Other Organization Name | PROVIDENCE EASTSIDE ONCOLOGY & HEMATOLOGY CLINIC |
| Practice Address |
4805 Ne Glisan St Ste 11n Portland OR 97213-2933 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032155696 |
| Mailing Telephone | 5032156494 |
| Mailing Fax Number | 5032156644 |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2019-08-19 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASST CORP SECRETARY FOR ENROLLMENTS) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 270985 | 05 |
| Other Name | Type Code |
|---|---|
| PROVIDENCE EASTSIDE ONCOLOGY & HEMATOLOGY CLINIC | 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 |
| 1003319724 | Providence Health & Services Oregon | Clinic/Center | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-03-09 |
| Street Address |
4805 NE GLISAN ST STE 11N |
| City | PORTLAND |
| State | OR |
| Zip Code | 97213-2933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801010004 | Providence Health & Services Oregon | Internal Medicine | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2007-04-12 |
| 1205479441 | Angie M Kang | Pharmacist | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2019-10-21 |
| 1023576659 | Rhezarie Mae A Agtarap | Registered Nurse | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2019-03-01 |
| 1154809903 | Molly Christine Davis | Nurse Practitioner | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2018-08-03 |
| 1649716267 | Garrett Wilson | Physician Assistant | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2017-01-07 |
| 1336568369 | Hasnain A Hasham | Radiology | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2014-04-07 |
| 1497098941 | Evelyn M Brosnan | Internal Medicine | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2013-04-03 |
| 1063655967 | Heidi J Hansen | Dentist | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2009-04-08 |
| 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 | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366860553 | Daniel Guy | Internal Medicine | 4805 Ne Glisan St Ste 11n-1, Portland, OR 97213-2933 | 2014-04-03 |
| 1033464318 | William Galen | Internal Medicine | 1221 Sw 10th Ave, 1804, Portland, OR 97205-2426 | 2012-07-23 |
| 1730348632 | Sasha Elizabeth Stanton | Internal Medicine | 4805 Ne Glisan St # 2n103, Portland, OR 97213-2933 | 2008-06-05 |
| 1801010004 | Providence Health & Services Oregon | Internal Medicine | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2007-04-12 |
| 1649392135 | Rosemarie Mannino | Internal Medicine | 3710 Sw Us Veteran Hospital Rd, Portland, OR 97239 | 2007-04-04 |
| 1649312398 | Ivan P Law Md PC | Internal Medicine | 2707 Ne 33rd Ave, Portland, OR 97212-3649 | 2007-02-12 |
| 1700960671 | Gina Vaccaro | Internal Medicine | 9135 Sw Barnes Rd Ste 261, Portland, OR 97225-6784 | 2006-10-25 |
| 1528073012 | Brian Jay Druker | Internal Medicine | 3181 Sw Sam Jackson Park Rd, L952, Portland, OR 97239 | 2006-07-31 |
| 1265475198 | Maria Gia Gregorio | Internal Medicine | 10859 Nw Supreme Ct, Portland, OR 97229-8816 | 2006-06-14 |
| 1124021753 | Stacy K Lewis | Internal Medicine | 9135 Sw Barnes Rd, Ste 261, Portland, OR 97225-6601 | 2005-05-27 |
| 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.