PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1770723017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770723017 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PMG BRIDGEPORT DERMATOLOGY |
| Practice Address |
18040 Sw Lower Boones Ferry Rd Suite 100 Tigard OR 97224-7215 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032160700 |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2010-04-19 |
| 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 |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| PMG BRIDGEPORT DERMATOLOGY | 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 |
18040 SW LOWER BOONES FERRY RD SUITE 100 |
| City | TIGARD |
| State | OR |
| Zip Code | 97224-7215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952384430 | Pamela A. Devisser | Nurse Practitioner | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7258 | 2005-11-29 |
| 1689211740 | Gabrielle Johnson | Specialist/Technologist | 18040 Sw Lower Boones Ferry Rd, Tigard, OR 97224-7258 | 2019-12-06 |
| 1326588708 | Susan Kathleen Glinka | Psychologist | 18040 Sw Lower Boones Ferry Rd, Suite 304, Tigard, OR 97224-7258 | 2017-03-03 |
| 1720402472 | Providence Health & Services - Oregon | Internal Medicine | 18040 Sw Lower Boones Ferry Rd, Suite 204, Tigard, OR 97224-7259 | 2014-02-14 |
| 1689097131 | Providence Health & Services - Oregon | Internal Medicine | 18040 Sw Lower Boones Ferry Rd, Suite 204, Tigard, OR 97224-7259 | 2014-02-03 |
| 1790113405 | Providence Health & Services - Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7259 | 2013-10-16 |
| 1669726345 | Deborah Ann Jones | Physical Therapist | 18040 Sw Lower Boones Ferry Rd, Tigard, OR 97224-7258 | 2012-11-02 |
| 1568749539 | Heather Leann Adair | Physician Assistant | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7258 | 2011-11-04 |
| 1568756591 | Michael D Goodwin | Family Medicine | 18040 Sw Lower Boones Ferry Rd, Ste 100, Tigard, OR 97224-7258 | 2011-06-07 |
| 1245549724 | Providence Health & Services Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 207, Tigard, OR 97224-7259 | 2010-09-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154973139 | Katherine Raineri | Psychologist | 7213 Sw Hazel Fern Rd, Tigard, OR 97224 | 2019-07-10 |
| 1871064618 | Stacey A Wenzel | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Rd.,suite 201, Tigard, OR 97224 | 2018-12-05 |
| 1376010090 | Meredith Rae Brezinski | Physical Therapist | 18019 Sw Boones Ferry Road, Tigard, OR 97224 | 2018-10-31 |
| 1649759358 | Viktoriya A Chiliy | Behavior Technician | 15290 Sw Royalty Parkway, Tigard, OR 97224 | 2018-08-13 |
| 1609384866 | Rachel E King | Physical Therapist | 18040 Sw Lower Boones Ferry Rd Ste 200, Tigard, OR 97224 | 2018-01-22 |
| 1689190134 | Isabelle Cooper Klee Caballero | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Road Suite 201, Tigard, OR 97224 | 2017-08-16 |
| 1427573146 | Breanna M Sandefur | Behavior Technician | 15290 Sw Royalty Pkwy, Tigard, OR 97224 | 2017-08-03 |
| 1083141196 | Krista Espenship | Registered Nurse | 8032 Sw Ashford St, Tigard, OR 97224 | 2017-05-19 |
| 1275067928 | Emily Elizabeth Myers | Behavioral Analyst | 15290 Royalty Parkway, Tigard, OR 97224 | 2017-04-19 |
| 1235684937 | Melanie Salvador | Nurse Practitioner | 15352 Sw Oakmont Pl, Tigard, OR 97224 | 2016-08-23 |
| Find all providers in zip 97224 | ||||
| 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 |
|---|---|---|---|---|
| 1336704071 | Integrated Joint Specialists LLC | Clinic/Center | 10250 Sw Greenburg Rd Ste 115, Tigard, OR 97223-5461 | 2019-05-08 |
| 1457819971 | Advanced Acupuncture & Oriental Medicine, LLC | Clinic/Center | 9735 Sw Shady Ln Ste 306, Tigard, OR 97223-5481 | 2019-03-04 |
| 1780199679 | Ideal Option, Pllc | Clinic/Center | 9735 Sw Shady Ln Ste 103, Tigard, OR 97223-5481 | 2017-12-13 |
| 1790113405 | Providence Health & Services - Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7259 | 2013-10-16 |
| 1568715019 | Metis Clinics | Clinic/Center | 7110 Sw Fir Loop, Suite 210, Tigard, OR 97223-8084 | 2012-10-22 |
| 1053670117 | Tigard Holistic Health Clinic, LLC | Clinic/Center | 11930 Sw Greenburg Rd, Tigard, OR 97223-6453 | 2012-05-10 |
| 1245549724 | Providence Health & Services Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 207, Tigard, OR 97224-7259 | 2010-09-30 |
| 1588981963 | Providence Health & Services - Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 204, Tigard, OR 97224-7259 | 2010-04-26 |
| 1821224957 | Providence Health & Services Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224 | 2009-06-03 |
| 1841452521 | Providence Health & Services - Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7215 | 2008-06-25 |
| Find all providers in TIGARD | ||||
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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.