Providence Health & Services Oregon

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

Legal business name

PROVIDENCE HEALTH & SERVICES OREGON

Doing business as

Providence Medcial Group
Providence St Vincent Heart Clinics Cardiology Doctors Clinic Salem

Practice address

5050 Skyline Village Loop S
Salem, OR 97306-9490

Phone

(503) 291-2123

NPI assigned

Jun 23, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Donald Wayne Anderson Jr.

Title

Asst Sec Enrollment

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• PROVIDENCE MEDCIAL GROUP Doing business as
• Providence St Vincent Heart Clinics Cardiology Doctors Clinic Salem Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751587200000",
    "number": "1265743330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 SKYLINE VILLAGE LOOP S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973069490",
            "telephone_number": "503-291-2123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-23",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASST SEC ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500630291",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDCIAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence St Vincent Heart Clinics Cardiology Doctors Clinic Salem",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence St Vincent Heart Clinics Cardiology Doctors Clinic Salem",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Project Able, Inc.
• Courtney Prokosch, PSYD
• David Prosser, M.D.
• Hillary Kay Provance-Wheeler, LPC
• Providence Health & Services - Oregon (Prov Peds Neurology Salem)
• Providence Health & Services Oregon (Providence Home Medical Equipment)
• Linda L. Prudhomme, LCSW
• Whitney Pruett, LPN
• Alicia Pruitt
• Christopher Thomas Prze, MD

• Interventional Cardiology Physician in Salem, OR
• Providers in Salem, OR by specialty
• Interventional Cardiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.