PROVIDENCE HEALTH & SERVICES OREGON (NPI# 1992138309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992138309 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES OREGON |
| Other Organization Name | PROVIDENCE WILLAMETTE FALLS CHILD ADOLESCENT OUTPATIENT PSYCHIATRY |
| Practice Address |
1511 Division St Ste 101 Oregon City OR 97045-1589 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5037223705 |
| Practice Fax Number | 5037223750 |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2019-04-24 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASST CORP SECRETARY FOR ENROLLMENTS) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Providence Willamette Falls Child Adolescent Outpatient Psychiatry | 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 |
1511 DIVISION ST STE 101 |
| City | OREGON CITY |
| State | OR |
| Zip Code | 97045-1589 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700122058 | Northwest Primary Care Group, PC | Family Medicine | 1511 Division St Ste 101, Oregon City, OR 97045-1589 | 2012-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528625621 | Dylan Wile | Physical Therapist | 19721 Or 213, Oregon City, OR 97045 | 2019-05-23 |
| 1952871576 | April Saylor | Dental Hygienist | 15530 S. Morel Dr, Oregon City, OR 97045 | 2018-11-27 |
| 1598251688 | Sara Noelle Wetten | Dental Assistant | 1900 Mclouglin Blvd #68, Oregon City, OR 97045 | 2018-07-02 |
| 1649761941 | Carol Ann Cranfill | Specialist | 1001 Molalla Ave. Ste 206, Oregon City, OR 97045 | 2018-05-22 |
| 1790286029 | Kathleen Walker | Registered Nurse | 110 Beaverceek Rd., Oregon City, OR 97045 | 2018-02-22 |
| 1174032429 | Amanda Brannin | Dental Hygienist | 15018 Pebble Beach Dr, Oregon City, OR 97045 | 2017-09-28 |
| 1003332669 | Clackamas Medical Supplies | Durable Medical Equipment & Medical Supplies | 2050 Beavercreek Rd. Ste 101-385, Oregon, OR 97045 | 2017-08-16 |
| 1154870129 | Staci S Meador | Nurse Practitioner | 1508 Division St Ste 200, Oregon City, OR 97045 | 2016-10-01 |
| 1821541939 | Samuel R. Sabo | General Practice | 18171 Waldow Rd., Oregon City, OR 97045 | 2016-07-26 |
| 1619339967 | Carly Chambers | Physical Therapist | 1630 S Beavercreeak Rd, Suite A, Oregon City, OR 97045 | 2016-03-25 |
| Find all providers in zip 97045 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629273594 | Arkady A. Klykov | Internal Medicine | 1500 Division Street, Oregon City, OR 97045-1527 | 2007-06-19 |
| 1154539203 | Providence Health & Services | Internal Medicine | 1510 Division St Ste 200, Oregon City, OR 97045-1599 | 2007-05-21 |
| 1750474490 | Richard Goldenberg | Internal Medicine | 1510 Division Street, Suite 200, Oregon City, OR 97045 | 2006-10-02 |
| 1356392559 | George M Edwards | Internal Medicine | 1001 Molalla Ave Ste 100, Oregon City, OR 97045-3753 | 2006-05-12 |
| 1265870489 | Amer F Salam | Internal Medicine | 1500 Division St, Oregon City, OR 97045-1527 | 2013-06-10 |
| 1932546504 | Brandon Young | Internal Medicine | 1500 Division St, Oregon City, OR 97045-1527 | 2013-05-23 |
| 1285970343 | Tian Yu Davis | Internal Medicine | 1500 Division St, Oregon City, OR 97045-1527 | 2012-12-18 |
| 1750607594 | Aaron J Chan | Internal Medicine | 1500 Division St, Oregon City, OR 97045-1527 | 2010-04-19 |
| 1295964310 | Danielle Cataxinos | Internal Medicine | 1500 Division St, Oregon City, OR 97045-1527 | 2009-07-10 |
| 1710113386 | Jesus Armando Moreno | Internal Medicine | 1500 Division St, Oregon City, OR 97045-1527 | 2009-06-09 |
| Find all providers in OREGON CITY | ||||
| City | OREGON CITY |
| Zip Code | 97045 |
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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.