Providence Health and Services Oregon
Organization Active NPI Family Medicine Physician · Vancouver, WA
NPI 1366748550 · NPPES record last updated Jun 30, 2025
Key facts
- NPI
- 1366748550
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- PROVIDENCE HEALTH AND SERVICES OREGON
- Practice address
- 315 SE Stonemill Dr Ste 220
Vancouver, WA 98684-6987 - Phone
- (360) 687-6650
- NPI assigned
- Feb 4, 2011
- Organization subpart
- No
Authorized official
- Name
- Donald Wayne Anderson Jr.
- Title
- Assistant Secretary Enrollments
- Phone
- (425) 358-9786
Other NPIs on the same Medicare enrollment 14
Practitioners 4
-
Yi Mao, MBBS
-
Clara Louise Peck, M.D.
-
Helen Z Zhang, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080630000201 | WA | Part B Supplier - Clinic/Group Practice | 0648183608 |
Receives reassigned benefits from 77 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
315 SE Stonemill Dr Ste 220
Vancouver, WA 98684-6987
Mailing address
PO Box 31001 - 4180
Pasadena, CA 91110-4180
Phone (425) 358-9786
Other practice location 1
101 NW 12TH Avenue
Suite 107
Battle Ground, WA 98604-9141
Phone (360) 666-8418
Other names
- PROVIDENCE MEDICAL GROUP
Other providers in Vancouver, WA
- Providence Health & Services - Oregon
- Providence Health & Services - Oregon
- Providence Health & Services Oregon
- Providence Health & Services Oregon
- Providence Health & Services-Oregon
- Joseph Province
- Michelle Nicole Provost
- Pierre E Provost V
- Brandy Pruett
- David Franklin Pruette
All providers in Vancouver, WA · Family Medicine 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 Jun 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.