Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Providence Health & Services Oregon

Organization Pediatrics Physician · NPI 1104097906

Providence Health & Services Oregon is a Pediatrics Physician in Longview, Washington. Registered with an NPI since 2008.

In the registry since
2008
Specialties on file
2
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Practice location Address checks out

971 11th Ave
Longview, WA 98632-2503
Phone: (360) 577-1771
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1104097906
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Health & Services - Oregon
Authorized official Donald Anderson — Assistant Secretary Of Enrollments · (425) 358-9786
Other names Prov Peds Neurology Longview; Providence Medical Group
NPI enumeratedMarch 19, 2008
Last updated in NPPESJune 20, 2025
Certification dateJune 20, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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