PROVIDENCE HEALTH & SERVICES OREGON (NPI# 1801010004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801010004 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES OREGON |
| Other Organization Name | PROVIDENCE LIVER CANCER CLINIC |
| Practice Address |
4805 Ne Glisan St Ste 11n Portland OR 97213-2933 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032158650 |
| Practice Fax Number | 5032158653 |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2019-07-19 |
| Authorized Official Name | DONALD WAYNE ANDERSON (ASST CORP SECRETARY FOR ENROLLMENTS) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0008X |
Internal Medicine Specialization: Hepatology |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 2086X0206X |
Surgery Specialization: Surgical Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 274461 | 05 |
| Other Name | Type Code |
|---|---|
| PROVIDENCE LIVER CANCER 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 |
| 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 |
| 1972039170 | Providence Health & Services Oregon | Clinic/Center | 171 S Highway 101, Warrenton, OR 97146 | 2017-05-08 |
| Street Address |
4805 NE GLISAN ST STE 11N |
| City | PORTLAND |
| State | OR |
| Zip Code | 97213-2933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479441 | Angie M Kang | Pharmacist | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2019-10-21 |
| 1023576659 | Rhezarie Mae A Agtarap | Registered Nurse | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2019-03-01 |
| 1154809903 | Molly Christine Davis | Nurse Practitioner | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2018-08-03 |
| 1649716267 | Garrett Wilson | Physician Assistant | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2017-01-07 |
| 1336568369 | Hasnain A Hasham | Radiology | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2014-04-07 |
| 1497098941 | Evelyn M Brosnan | Internal Medicine | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2013-04-03 |
| 1063655967 | Heidi J Hansen | Dentist | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2009-04-08 |
| 1316197692 | Providence Health & Services Oregon | Clinic/Center | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2008-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831715176 | Darnell Jackie Strong | Social Worker | 435 Ne 78th Ave 'strong Counseling Services', Portland, OR 97213 | 2020-06-23 |
| 1336775907 | Redpoint Physical Therapy and Performance LLC | Physical Therapist | 4200 Ne Flanders St Unit B, Portland, OR 97213 | 2020-03-16 |
| 1801431218 | Denise Dorgan-miller | Occupational Therapy Assistant | Providence Elder Place, 4400 Ne Halsey Suite 200, Portland, OR 97213 | 2019-11-08 |
| 1619435617 | Aspiration of Character Counseling Services, LLC | Counselor | 4424 Ne Glisan St, The Li Wellness Building, Second Floor, Portland, OR 97213 | 2019-03-08 |
| 1578049631 | Credena Health LLC | Pharmacy | 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 | 2018-07-12 |
| 1023507795 | Karissa Lynn Schwartz | Speech-Language Pathologist | Providence Portland Medical Center, 4805 Ne Glisan St, Portland, OR 97213 | 2018-05-08 |
| 1861944506 | James Livingston Taylor | Chiropractor | 5212 Ne Sacremento St., Portland, OR 97213 | 2016-10-28 |
| 1962958520 | Caitlin Turner | Massage Therapist | 4317 Ne Tillamook St., Portland, OR 97213 | 2016-09-01 |
| 1326407008 | Julianna Vermeys | Counselor | 4605 Ne Fremont St., 209a, Portland, OR 97213 | 2016-02-23 |
| 1881059822 | Thomas Michael Barrett | Counselor | 5228 Ne Hoyt St. Bldg. B, Portland, OR 97213 | 2015-12-17 |
| Find all providers in zip 97213 | ||||
| Taxonomy Code | 207RX0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Medical Oncology |
| An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source. 11/5/2007: corrected definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023351137 | Apurva Pandey | Internal Medicine | 1130 Nw 22nd Ave Ste 150, Portland, OR 97210-2974 | 2013-03-27 |
| 1013932854 | Robert Charles Lufkin | Internal Medicine | 5050 Ne Hoyt St Ste 256, Portland, OR 97213-2982 | 2006-07-13 |
| 1558364570 | Bruce Wilson Dana | Internal Medicine | 5050 Ne Hoyt St, Ste 256, Portland, OR 97213-2982 | 2005-05-23 |
| 1255740965 | Providence Health & Services - Oregon | Internal Medicine | 9135 Sw Barnes Rd, Suite 261, Portland, OR 97225-6784 | 2014-08-06 |
| 1750708202 | Theodore Paul Braun | Internal Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2014-03-22 |
| 1437595857 | Providence Health & Services - Oregon | Internal Medicine | 4805 Ne Glisan St, Suite 6n40, Portland, OR 97213-2933 | 2013-05-13 |
| 1295171767 | Providence Health & Services - Oregon | Internal Medicine | 9135 Sw Barnes Rd, Suite 261, Portland, OR 97225-6784 | 2013-05-10 |
| 1235400177 | Adel Kardosh | Internal Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239 | 2012-01-24 |
| 1346520327 | Providence Health & Services - Oregon | Internal Medicine | 9135 Sw Barnes Rd, Suite 261, Portland, OR 97225-6784 | 2011-08-23 |
| 1700166782 | Providence Health & Services - Oregon | Internal Medicine | 4805 Ne Glisan St, Suite 6n50, Portland, OR 97213-2933 | 2011-08-23 |
| 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.