PROVIDENCE HEALTH & SERVICES OREGON (NPI# 1649344458) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649344458 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES OREGON |
| Other Organization Name | PROVIDENCE SEASIDE HOSPITAL, PROVIDENCE SEASIDE CLINIC |
| Practice Address |
727 S Wahanna Rd Seaside OR 97138 |
| Mailing Address |
Po Box 3397 Portland OR 97208-3397 |
| Practice Telephone | 5037177000 |
| Mailing Telephone | 5032154323 |
| Mailing Fax Number | 5032150297 |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2018-06-06 |
| Authorized Official Name | DONALD ANDERSON JR. (ASST CORP SEC FOR ENROLLMENTS) |
| Authorized Official Telephone | 4255255392 |
| Authorized Official Credential | ASST CORP SEC FO |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE SEASIDE HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 000138 | 05 | |
| OR | MEDICAID CLINIC - 1500 BILLING | 039607 | 01 |
| OR | REGENCE BCBSO CLINIC # | 015560000 | 01 |
| OR | RAILROAD MEDICARE | C13774 | 01 |
| OR | WASHINGTON MEDICAID | 7042567 | 01 |
| Other Name | Type Code |
|---|---|
| Providence Seaside Hospital, Providence Seaside Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518425693 | Providence Health & Services Oregon | Durable Medical Equipment & Medical Supplies | 2296 Nw Kings Blvd Ste 101, Corvallis, OR 97330-3871 | 2019-03-07 |
| 1841756764 | Providence Health & Services Oregon | Family Medicine | 171 N Larch St Ste 16, Cannon Beach, OR 97110-3103 | 2019-02-15 |
| 1346751443 | Providence Health & Services Oregon | General Practice | 4400 Ne Halsey St, Pop 2, 3rd Floor, Portland, OR 97213-1545 | 2017-10-16 |
| 1922453943 | Providence Health & Services Oregon | Assisted Living Facility | 1550 Brookside Dr, Hood River, OR 97031-8553 | 2016-04-27 |
| 1649541020 | Providence Health & Services Oregon | Clinic/Center | 211 Ne Skyline Dr, White Salmon, WA 98672 | 2012-01-18 |
| 1922330828 | Providence Health & Services Oregon | Pharmacy | 18040 Sw Lower Boones Ferry Rd Ste 104, Tigard, OR 97224-7259 | 2010-02-03 |
| 1801010004 | Providence Health & Services Oregon | Internal Medicine | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2007-04-12 |
| 1487746491 | Providence Health & Services Oregon | Home Health | 2033 Commerce Dr, Medford, OR 97504-9744 | 2006-09-28 |
| 1831196302 | Providence Health & Services Oregon | Home Health | 570 S Main Street, Mount Angel, OR 97362-9540 | 2005-06-30 |
| 1003319724 | Providence Health & Services Oregon | Clinic/Center | 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 | 2018-03-09 |
| Street Address |
727 S WAHANNA RD |
| City | SEASIDE |
| State | OR |
| Zip Code | 97138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386647923 | Ravindra R Patil | Internal Medicine | 727 S Wahanna Rd, Seaside, OR 97138-7735 | 2005-05-27 |
| 1689229940 | Jacquelyn L Welborn | Nurse Practitioner | 727 S Wahanna Rd, Seaside, OR 97138-7735 | 2019-08-05 |
| 1871040857 | Allison K Walkowski | Nurse Practitioner | 727 S Wahanna Rd, Seaside, OR 97138-7735 | 2016-09-07 |
| 1255751921 | Steven Kyle Dailey | Orthopaedic Surgery | 727 S Wahanna Rd, Seaside, OR 97138-7735 | 2014-04-22 |
| 1902223050 | Jiyeon Jeon | Family Medicine | 727 S Wahanna Rd, Seaside, OR 97138-7735 | 2014-03-26 |
| 1184941619 | Providence Health & Services - Oregon | Clinic/Center | 727 S Wahanna Rd, Suite 101, Seaside, OR 97138-7735 | 2010-04-23 |
| 1598897027 | Mitra Oncology Associates, P.C. | Internal Medicine | 727 S Wahanna Rd, Seaside, OR 97138-7735 | 2007-03-10 |
| 1316928674 | Alfred Brooke Benz | Orthopaedic Surgery | 727 S Wahanna Rd, Seaside, OR 97138-7735 | 2005-11-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881238376 | Abigail Mcneil | Social Worker | 1150 N Roosevelt Dr., Suite 104, Seaside, OR 97138 | 2019-10-29 |
| 1124564455 | Shelby James | Massage Therapist | 620 S Holladay Dr Ste 3, Seaside, OR 97138 | 2017-01-10 |
| 1699151902 | Joseph Alphonse Sutton | Pharmacist | 79380 Highway 202, Seaside, OR 97138 | 2015-08-10 |
| 1487047197 | Seaside Dental Clinic | Dentist | 729 S Holladay Drive, Seaside, OR 97138 | 2015-03-05 |
| 1215331020 | Jessica Jones | Massage Therapist | 1601 S. Roosevelt, Seaside, OR 97138 | 2014-10-22 |
| 1952735987 | Derk Penrod | Pharmacist | 401 S Roosevelt, Seaside, OR 97138 | 2013-08-27 |
| 1194166025 | Scott Allen Kafader | Pharmacist | 1150 N. Roosevelt Dr., Suite 104, Seaside, OR 97138 | 2013-07-08 |
| 1326391459 | Addiction Medicine Consulting | Substance Abuse Rehabilitation Facility | 1325 North Holladay Dr., Seaside, OR 97138 | 2012-10-26 |
| 1548552938 | Robert W Olson | Pharmacist | 313 S Rosevelt Drive, Seaside, OR 97138 | 2011-05-04 |
| 1831395144 | Delores Swigert Sullivan | Social Worker | 564 Pacific Way, Gearhart, OR 97138 | 2007-06-23 |
| Find all providers in zip 97138 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225694706 | Columbia Lutheran Charities | Clinic/Center | 1111 N Roosevelt Dr Ste 210, Seaside, OR 97138-4604 | 2019-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183063 | Praxis Medical Group P.C. | Clinic/Center | 1890 7th St., Umatilla, OR 97882 | 2020-10-27 |
| 1336749621 | Praxis Medical Group P.C. | Clinic/Center | 2011 Fourth St., La Grande, OR 97850 | 2020-10-27 |
| 1093296519 | Grande Ronde Hospital, Inc. | Clinic/Center | 10303 S Walton Rd, La Grande, OR 97850 | 2018-08-23 |
| 1285164921 | Northwest Medical Foundation of Tillamook | Clinic/Center | 1005 Cougar St, Vernonia, OR 97064-1282 | 2017-06-15 |
| 1043694342 | Grande Ronde Hospital, Inc | Clinic/Center | 570 8th, Elgin, OR 97827 | 2015-07-16 |
| 1992183859 | Centennial Medical Group East, LLC | Clinic/Center | 145 E. Broadway, Myrtle Creek, OR 97457 | 2015-05-12 |
| 1477945517 | Morrow County Health District | Clinic/Center | 365 W 3rd St, Ione, OR 97843-7216 | 2015-02-26 |
| 1699183236 | Lake Health District | Clinic/Center | 700 South J St, Lakeview, OR 97630 | 2014-07-28 |
| 1487919783 | Aurora Family Health and Maternity Care Services LLC | Clinic/Center | 21358 Hwy 99e Ne, Aurora, OR 97002 | 2012-07-12 |
| 1508122763 | Mid-valley Healthcare, Inc. | Clinic/Center | 35 Mullins Drive, Suite 2, Lebanon, OR 97355 | 2012-04-02 |
| 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.