PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1235479643) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235479643 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP SPORTS CARE |
| Practice Address |
909 Sw 18th Ave Portland OR 97205-1705 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5039621946 |
| Practice Fax Number | 5039621925 |
| Mailing Telephone | 5032156494 |
| Mailing Fax Number | 5032156644 |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2013-03-12 |
| 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 | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RS0010X |
Internal Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Providence Medical Group Sports Care | 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 |
909 SW 18TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97205-1705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629046602 | Rebecca D Fedie | Physical Therapist | 909 Sw 18th Ave, Portland, OR 97205-1705 | 2006-03-08 |
| 1679052930 | Daryl Ewing | Physical Therapist | 909 Sw 18th Ave, Portland, OR 97205-1705 | 2018-08-08 |
| 1124474002 | Oliya Yegorov | Speech-Language Pathologist | 909 Sw 18th Ave, Portland, OR 97205-1705 | 2016-05-10 |
| 1881049922 | Haley Faye Lafleur | Physical Therapist | 909 Sw 18th Ave, Portland, OR 97205 | 2016-04-26 |
| 1073988226 | Katherine Donnelley | Specialist/Technologist | 909 Sw 18th Ave, Portland, OR 97205-1705 | 2015-12-14 |
| 1487060562 | Kasey Webber | Specialist | 909 Sw 18th Ave, Portland, OR 97106 | 2014-07-09 |
| 1700151065 | Oregon Sports Medicine Associates | Orthopaedic Surgery | 909 Sw 18th Ave, Portland, OR 97205-1705 | 2012-03-19 |
| 1073802344 | Providence Health & Services Oregon | Clinic/Center | 909 Sw 18th Ave, Portland, OR 97205-1705 | 2011-04-07 |
| 1265768741 | Nicholas Mark Thompson | Physical Therapist | 909 Sw 18th Ave, Portland, OR 97205-1705 | 2009-10-19 |
| 1417169517 | Eric J. Marchek | Physical Therapist | 909 Sw 18th Ave, Portland, OR 97205-1705 | 2007-05-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871026062 | Leila Soltani | Dentist | 430 Sw 13th Ave Apt 2010, Portland, OR 97205 | 2017-04-05 |
| 1114374949 | Elizabeth Alire | Counselor | 1411 Sw Morrison St., Portland, OR 97205 | 2016-05-23 |
| 1508237462 | Pacific Psychology and Comprehensive Health Center | Community/Behavioral Health | 1411 Sw Morrison Ave, Suite 310, Portland, OR 97205 | 2015-10-16 |
| 1265803761 | Alana Branson | Naturopath | 1033 Sw Yamhill Street, Suite 403, Portland, OR 97205 | 2015-10-10 |
| 1720458011 | Kate Ohene | Counselor | 1411 Sw Morrison Street, Suite 310, Portland, OR 97205 | 2015-09-30 |
| 1285004671 | Christina Nannette Mendoza | Counselor | 1411 Sw Morriston Street, 310, Portland, OR 97205 | 2015-09-29 |
| 1083095947 | Patricia Burton | Registered Nurse | 1312 Sw Washinghton, Portland, OR 97205 | 2015-06-16 |
| 1649663071 | Huey Holistic | Clinic/Center | 1221 Sw Yamill, Suite 300, Portland, OR 97205 | 2015-03-10 |
| 1376952796 | Joan Kendall Ayala | Counselor | 610 Sw Alder St Ste 915, Portland, OR 97205 | 2014-08-11 |
| 1316356165 | Satheara Sin | Massage Therapist | 1033 Sw Yamhill St. #403, Portland, OR 97205 | 2014-08-06 |
| Find all providers in zip 97205 | ||||
| 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 |
|---|---|---|---|---|
| 1801413240 | Gfm LLC | Clinic/Center | 1235 Se Division St Ste 114, Portland, OR 97202-1042 | 2020-07-01 |
| 1134750037 | Legacy Good Samaritan Hospital and Medical Center | Clinic/Center | 1040 Nw 22nd Ave Ste 250, Portland, OR 97210-3057 | 2020-01-29 |
| 1679030290 | Yoana Kanev | Clinic/Center | 3701 Sw Condor Ave Apt C1, Portland, OR 97239-4158 | 2019-03-01 |
| 1841760584 | Orthopedic Needle LLC | Clinic/Center | 328 Ne Failing St Ste C, Portland, OR 97212-1157 | 2018-11-26 |
| 1073081881 | Sober Living Oregon Recovery Center | Clinic/Center | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2018-11-09 |
| 1366933830 | Dr Frances V Verzosa Md PC | Clinic/Center | 12770 Se Stark St Bldg C, Portland, OR 97233-1539 | 2018-05-21 |
| 1023520814 | Concordia Wellness, LLC | Clinic/Center | 3014 Ne Killingsworth St, Portland, OR 97211-6814 | 2017-11-01 |
| 1114443124 | Zephyr Acupuncture and Bodywork, LLC | Clinic/Center | 4313 Ne Tillamook St, Portland, OR 97213-1315 | 2017-08-22 |
| 1164952495 | Earth Source Medicine | Clinic/Center | 2207 Ne Broadway St Ste 200, Portland, OR 97232-1791 | 2017-06-19 |
| 1902353873 | Siesta Acupuncture LLC | Clinic/Center | 2818 Se 70th Ave, Portland, OR 97206-1117 | 2016-09-08 |
| 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.