PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1629146121) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629146121 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PMG NEWBERG SURGICAL SERVICES |
| Practice Address |
310 Villa Rd Suite 104 Newberg OR 97132-1886 |
| Mailing Address |
Po Box 4949 Portland OR 97208-4949 |
| Practice Telephone | 5035371508 |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2010-04-16 |
| Authorized Official Name | MITCHELL NEYHART (CHIEF FINANCE OFFICER) |
| Authorized Official Telephone | 5035749840 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 022849 | 05 |
| Other Name | Type Code |
|---|---|
| PMG NEWBERG SURGICAL SERVICES | 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 |
| 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 |
| 1235595299 | Providence Health & Services - Oregon | Clinic/Center | 174 1st Ave N, Ilwaco, WA 98624-9137 | 2016-01-06 |
| 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 |
310 VILLA RD SUITE 104 |
| City | NEWBERG |
| State | OR |
| Zip Code | 97132-1886 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396266193 | Casandra Nicole Glatz | Speech-Language Pathologist | 310 Villa Rd, Newberg, OR 97132-1886 | 2017-06-30 |
| 1598202152 | Kyla Laraway | Occupational Therapist | 310 Villa Rd, Newberg, OR 97132-1886 | 2017-01-20 |
| 1669645842 | Heather Marie Larson | Audiologist | 310 Villa Rd, Suite 104, Newberg, OR 97132-1886 | 2008-04-08 |
| 1871703298 | Deborah Lee Trevvett | Speech-Language Pathologist | 310 Villa Rd, Suite 104, Newberg, OR 97132-1886 | 2007-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720692007 | Gabrielle Anastasia Humlie | Dietitian, Registered | 109 W 8th St, Newberg, OR 97132 | 2020-09-03 |
| 1093278111 | Viva Wheaton Psyd LLC | Clinical Neuropsychologist | 603 E. Hancock St, Newberg, OR 97132 | 2019-04-08 |
| 1255847554 | John Nguyen | Physical Therapy Assistant | 1900 E. Fulton St., Newberg, OR 97132 | 2017-12-21 |
| 1154835338 | Breanne Embrey | Pharmacist | 1001 Providence Dr., Newberg, OR 97132 | 2017-11-26 |
| 1174063473 | Patricia Roberts | Hearing Instrument Specialist | 1014 B N Springbrook Rd, Newberg, OR 97132 | 2017-03-06 |
| 1477906048 | Dr. Marsha A. Green, L.L.C. | Community/Behavioral Health | 710c Foothills Dr, Ste 104, Newberg, OR 97132 | 2016-07-19 |
| 1760841308 | George Fox University Physical Therapy Community Clinic | Physical Therapist | 501 Villa Road, Newberg, OR 97132 | 2016-02-10 |
| 1013321389 | Jaecelle Guadiz Galeniece | Family Medicine | 1003 Providence Dr Ste 110, Newberg, OR 97132 | 2014-06-16 |
| 1790116978 | Nancy Stiehler Thurston | Psychologist | 501 N. Villa Rd., Newberg, OR 97132 | 2013-12-12 |
| 1700138856 | Kristen Z. Grbavac O'halloran | Physical Therapist | 1515 Portland Road, Suite 102, Newberg, OR 97132 | 2012-10-12 |
| Find all providers in zip 97132 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679675573 | Daniel John Brose | Surgery | 1201 Fulton St, #3, Newberg, OR 97132-1774 | 2006-09-01 |
| 1720200025 | Janelle Deanne Yutzie | Surgery | 1003 Providence Dr, Ste 210, Newberg, OR 97132-7523 | 2007-05-03 |
| 1053532564 | Gregory Michael Stroup | Surgery | 1003 Providence Dr, Suite 210, Newberg, OR 97132-7521 | 2007-05-01 |
| 1659463511 | Kim L Bui | Surgery | 1003 Providence Drive, Suite 210, Newberg, OR 97132 | 2006-09-29 |
| 1396770186 | Richard M Fisher | Surgery | 1003 Providence Dr, Suite # 210, Newberg, OR 97132-7521 | 2006-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386168029 | Northwest Minimally Invasive Surgery, LLC | Surgery | 2222 Nw Lovejoy St Ste 322, Portland, OR 97210-5101 | 2017-08-02 |
| 1366897399 | Andreas Hennig | Surgery | 783 Nw Naito Pkwy Apt 502, Portland, OR 97209-4755 | 2016-04-27 |
| 1366809048 | Mid-columbia Medical Center | Surgery | 1810 E. 19th St. #225, The Dalles, OR 97058 | 2016-01-26 |
| 1972983781 | Horizon Surgery Clinic | Surgery | 6542 Se Lake Rd Ste 101, Milwaukie, OR 97222-2245 | 2015-06-05 |
| 1871989467 | Cameron Cangelose | Surgery | 3181 Sw Sam Jackson Park Rd. L-579, Portland, OR 97239-3098 | 2015-04-09 |
| 1396157962 | Fernando Leon | Surgery | 2221 Sw First Ave Apt 2322, Portland, OR 97201-5023 | 2014-05-29 |
| 1114337466 | Thomas B Knowles | Surgery | 1130 Nw 22nd Ave Ste 500, Portland, OR 97210-2976 | 2014-05-07 |
| 1861811770 | Peter Andrew Sweeny | Surgery | 705 Elm St Sw Ste 300, Albany, OR 97321-1958 | 2014-04-08 |
| 1811310063 | George Craig Merhoff Sr. | Surgery | 6090 Sunset Ridge Rd, Klamath Falls, OR 97601-9386 | 2014-01-23 |
| 1659714160 | Sean Tyler Watters | Surgery | 5050 Ne Hoyt St Ste 651, Portland, OR 97213 | 2013-04-15 |
| 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.