Providence Health & Services - Oregon
Organization Active NPI Cardiovascular Disease Physician · Ilwaco, WA
NPI 1235595299 · NPPES record last updated Jul 4, 2025
Key facts
- NPI
- 1235595299
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- PROVIDENCE HEALTH & SERVICES - OREGON
- Practice address
- 174 1St Ave N
Ilwaco, WA 98624-9137 - Phone
- (503) 717-7850
- Fax
- (503) 216-0775
- NPI assigned
- Jan 6, 2016
- Organization subpart
- No
Authorized official
- Name
- Donald Wayne Anderson Jr.
- Title
- Assistant Secreatry for Enrollment
- Phone
- (425) 358-9786
Corporate family (same tax ID) 44
National Provider Directory
- Tax ID family
- Scholls Medical Group
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | Yes | ||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
174 1St Ave N
Ilwaco, WA 98624-9137
Mailing address
PO Box 31001 - 4180
Pasadena, CA 91110-4180
Other names
- PROVIDENCE MEDICAL GROUP
- Providence St Vincent Heart Care Clinic Ilwaco
Other providers in Ilwaco, WA
- Colin Irvin Holganza Ortiz
- Jacob Owings
- Pacific Heart Associates PC
- Peninsula Pharmacies Inc
- Peninsula Pharmacies Inc.
- Shirley M Pryor
- Public Hospital District 3 of Pacific County
- Public Hospital District 3 of Pacific County
- Public Hospital District 3 of Pacific County
- Public Hospital District 3 of Pacific County
All providers in Ilwaco, WA · Cardiovascular Disease Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.