PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1396149225) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396149225 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP GLISAN DERMATOLOGY AT MILWAUKIE |
| Practice Address |
10202 Se 32nd Ave Suite 702 Milwaukie OR 97222-3625 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032159080 |
| Practice Fax Number | 5032159099 |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2014-10-21 |
| 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 |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Providence Medical Group Glisan Dermatology at Milwaukie | 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 |
10202 SE 32ND AVE SUITE 702 |
| City | MILWAUKIE |
| State | OR |
| Zip Code | 97222-3625 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659369304 | Donald W. Fortlage | Pediatrics | 10202 Se 32nd Ave, Suite 201, Milwaukie, OR 97222-3610 | 2005-10-07 |
| 1225346661 | Justin David Galasso | Social Worker | 10202 Se 32nd Ave, Milwaukie, OR 97222-3610 | 2010-09-20 |
| 1407177934 | Oregon Cosmetic and Reconstructive Clinic, PC | Plastic Surgery | 10202 Se 32nd Ave, Suite 702, Milwaukie, OR 97222-3610 | 2010-06-18 |
| 1306077896 | Jonathan Reece Walker | Counselor | 10202 Se 32nd Ave, 504, Milwaukie, OR 97222-3610 | 2009-07-31 |
| 1225271133 | Milwaukie Orthopedic Service Inc | Orthopaedic Surgery | 10202 Se 32nd Ave, Suite 101, Milwaukie, OR 97222-3610 | 2009-04-08 |
| 1700079506 | Michael Thomas Dotter | Pharmacist | 10202 Se 32nd Ave, Suite 701, Milwaukie, OR 97222-3610 | 2007-08-24 |
| 1578765335 | Mihai Daniel Onofrei | Pharmacist | 10202 Se 32nd Ave, Suite 701, Milwaukie, OR 97222-3610 | 2007-06-04 |
| 1912128935 | Teresa Marie Maddalone Swift | Pharmacist | 10202 Se 32nd Ave, Milwaukie, OR 97222-3610 | 2007-05-01 |
| 1679793327 | John B Hardiman, Md Inc | Orthopaedic Surgery | 10202 Se 32nd Ave, Suite 101, Milwaukie, OR 97222-3610 | 2007-04-26 |
| 1164642831 | John Hardiman | Orthopaedic Surgery | 10202 Se 32nd Ave, Suite 101, Milwaukie, OR 97222-3610 | 2007-04-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831731397 | Madalyn Kelly Yowell | Technician | 7809 Southeast Southgate Street, Milwaukee, OR 97222 | 2019-10-16 |
| 1336617448 | Nadia Yang | Social Worker | 2115 Se Adams St, Milwaukie, OR 97222 | 2018-11-06 |
| 1851892368 | Arrow Dental LLC | Dentist | 10505 Se 17th Avenue, Milwaukie, OR 97222 | 2018-02-21 |
| 1851814016 | Cathy Maria Andrew | Acupuncturist | 11022 Se Stanley Ave, Milwaukie, OR 97222 | 2017-07-19 |
| 1972025369 | Sarah Elizabeth Giles | Peer Specialist | 11097 Se 21st Ave., Milwaukie, OR 97222 | 2017-07-07 |
| 1366976292 | Brittany Reubendale | Physical Therapist | 12705 See River Rd, Portland, OR 97222 | 2017-04-18 |
| 1669916383 | Margie Hertz | Registered Nurse | 6406 Se Cedarcrest Drive, Milwaukie, OR 97222 | 2016-12-14 |
| 1952858094 | Alexis Escobar | Speech-Language Pathologist | 4560 Se International Way, Ste 100, Milwaukie, OR 97222 | 2016-09-07 |
| 1205295466 | Beth Ann Mills | Acupuncturist | 2025 Se Jefferson St Ste 106, Milwaukie, OR 97222 | 2016-02-16 |
| 1558744086 | Kyle Eugene Coan | Specialist | 3306 Se Wister St, Milwaukie, OR 97222 | 2015-07-01 |
| Find all providers in zip 97222 | ||||
| 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 |
|---|---|---|---|---|
| 1659888212 | Body Works Wellness Center LLC | Clinic/Center | 2100 Se Lake Rd Ste 2d, Milwaukie, OR 97222-7759 | 2018-01-04 |
| 1891981999 | Milwaukie Chiropractic & Massage Clinic, PC | Clinic/Center | 5111 Se Lake Rd, Milwaukie, OR 97222-4767 | 2007-09-21 |
| 1780191924 | Kirsten Isakson, Lac | Clinic/Center | 7831 Se Lake Rd Ste 102, Milwaukie, OR 97267-2193 | 2018-01-09 |
| 1942749346 | Fornaturalhealing LLC | Clinic/Center | 11630 Se 40th Ave Ste C, Milwaukie, OR 97222-6195 | 2017-02-17 |
| 1548639719 | Planned Parenthood of The Columbia/willamette | Clinic/Center | 14411 Se Mcloughlin Blvd, Milwaukie, OR 97267-1412 | 2015-09-17 |
| 1053727636 | Providence Health & Services - Oregon | Clinic/Center | 3300 Se Dwyer Dr, Suite 304, Milwaukie, OR 97222-6548 | 2014-07-03 |
| 1356693873 | Milwaukie Urgent Care | Clinic/Center | 2403 Se Monroe St, Suite A, Milwaukie, OR 97222-7646 | 2012-10-08 |
| 1982997128 | Providence Health & Services - Oregon | Clinic/Center | 10330 Se 32nd Ave, Suite 210, Milwaukie, OR 97222-6594 | 2011-05-20 |
| 1316236847 | Whole Life Vitality | Clinic/Center | 2305 Se Washington St, Suite 104, Milwaukie, OR 97222-7647 | 2011-04-05 |
| 1578795936 | Hands On Chiropractic LLC | Clinic/Center | 13033 Se Rusk Rd, Milwaukie, OR 97222-2107 | 2009-08-19 |
| Find all providers in MILWAUKIE | ||||
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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.