PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1205937273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205937273 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP MERCANTILE |
| Practice Address |
4015 Mercantile Dr Suite 200 Lake Oswego OR 97035-2552 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032161500 |
| Practice Fax Number | 5032161515 |
| Mailing Telephone | 5032156494 |
| Mailing Fax Number | 5032156644 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-10-02 |
| Authorized Official Name | MR. DONALD W ANDERSON JR. (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Telephone | 4255255392 |
| 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 | 241291 | 05 |
| Other Name | Type Code |
|---|---|
| PROVIDENCE MEDICAL GROUP MERCANTILE | 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 |
4015 MERCANTILE DR SUITE 200 |
| City | LAKE OSWEGO |
| State | OR |
| Zip Code | 97035-2552 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295789428 | Gillian C Rosicky | Registered Nurse | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2006-05-20 |
| 1952770802 | Elizabeth York | Physician Assistant | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2015-09-22 |
| 1508201161 | Caroline Schmitz | Physician Assistant | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2013-05-08 |
| 1285832360 | Mary Beth Brown | Nurse Practitioner | 4015 Mercantile Dr, Ste 200, Lake Oswego, OR 97035-2552 | 2007-07-10 |
| 1699847731 | Darren Blaine Lewis | Family Medicine | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2006-11-14 |
| 1548370380 | Mark Stephen Jardini | Family Medicine | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2006-08-30 |
| 1417980335 | Kristina R Rashid | Family Medicine | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2006-07-07 |
| 1851322366 | Ruth A Fischer-wright | Family Medicine | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2006-07-05 |
| 1699715227 | Barbara Jean Britsch | Physician Assistant | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700127 | Teresa Siebenaler Scott | Social Worker | 3990 Sw Collins Way, Suite 202, Lake Owsego, OR 97035 | 2020-11-04 |
| 1528671567 | Martin Henry Lees | Internal Medicine | 14 Morningview Lane, Lake Oswego, OR 97035 | 2020-08-28 |
| 1356976187 | Premere Rehab LLC | Occupational Therapist | Infinity Rehab - The Springs At Lake Oswego, 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2020-03-12 |
| 1689212193 | Jennifer Chauvin | Nurse Practitioner | 20 Juarez Street, Lake Oswego, OR 97035 | 2019-12-16 |
| 1003396888 | Sarah Guenzburger | Physical Therapist | 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2018-08-21 |
| 1568964252 | Brett Johnson | Marriage & Family Therapist | 5655 Southwood Dr, Lake Oswego, OR 97035 | 2018-03-08 |
| 1912416561 | Michael Paul Long | Social Worker | 14523 Westlake Drive, Lake Oswego, Or 97035, Lake Oswego, OR 97035 | 2017-09-27 |
| 1467807859 | Misty Lohn | Nurse Practitioner | 5 Centerpointe Dr., Ste 600, Lake Oswego, OR 97035 | 2016-05-04 |
| 1326405473 | Kelsey Prince | Behavioral Analyst | 6400 Sw Rosewood St., Portland (lake Oswego), OR 97035 | 2016-01-20 |
| 1942683388 | Elizabeth Risberg Harrison | Massage Therapist | 190 Oswego Summit, Lake Oswego, OR 97035 | 2015-07-02 |
| Find all providers in zip 97035 | ||||
| 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 |
|---|---|---|---|---|
| 1205272267 | Z Clinic LLC | Clinic/Center | 16250 Bryant Rd, Suite 101, Lake Oswego, OR 97035-4300 | 2013-05-17 |
| 1568793313 | Providence Health & Services - Oregon | Clinic/Center | 17550 Provost St Ste 201, Lake Oswego, OR 97034-5199 | 2010-01-19 |
| 1578893962 | Monarch Medical Group LLC | Clinic/Center | 17020 Pilkington, Lake Oswego, OR 97035 | 2010-01-06 |
| 1477636561 | Pacific Medical Group, PC | Clinic/Center | 6 Centerpointe Drive, Ste 200, Lake Oswego, OR 97035 | 2006-10-23 |
| 1063860377 | Deni R Buss, Lmt | Clinic/Center | 14511 Westlake Dr, Suite 100, Lake Oswego, OR 97035-7783 | 2016-05-26 |
| 1023488343 | Providence Health & Services - Oregon | Clinic/Center | 4823 Meadows Rd, Lake Oswego, OR 97035-2529 | 2015-09-29 |
| 1982033494 | Amer J Mirza, Md PC | Clinic/Center | 4103 Mercantile Dr, Lake Oswego, OR 97035 | 2013-11-05 |
| 1376887992 | Justice Clinical Consults Inc | Clinic/Center | 315 2nd St, Lake Oswego, OR 97034-3114 | 2012-11-20 |
| 1639438419 | Janice Modesitt Lmt | Clinic/Center | 16463 Boones Ferry Rd, Ste. 100, Lake Oswego, OR 97035-4259 | 2012-05-14 |
| 1801062179 | Oakridge Medical Clinic | Clinic/Center | 4309 Oakridge Rd, Lake Oswego, OR 97035-3418 | 2008-05-06 |
| Find all providers in LAKE OSWEGO | ||||
| City | LAKE OSWEGO |
| Zip Code | 97035 |
Please comment or provide details below to improve the information on PROVIDENCE HEALTH & SERVICES - OREGON.
| 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.