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

Providence Health & Services - Oregon

Organization Child & Adolescent Psychiatry Physician · NPI 1316024128

Providence Health & Services - Oregon is a Child & Adolescent Psychiatry Physician in Medford, Oregon. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
3

Practice location Address checks out

840 Royal Ave Ste 110
Medford, OR 97504-6461
Phone: (541) 732-8370
Fax: (541) 732-8371
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Child & Adolescent Psychiatry Physician (primary) Taxonomy 2084P0804X
Clinic/Center Taxonomy 261Q00000X
Adolescent and Children Mental Health Clinic/Center Taxonomy 261QM0855X

Record details

NPI number1316024128
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Health & Services - Oregon
Authorized official Donald Anderson — Assistant Secretary Enrollment · (425) 358-9786
Other names Pmg South Medford Pediatrics; Pmg South Medford Pediatrics; Providence Medical Group South
NPI enumeratedNovember 1, 2006
Last updated in NPPESNovember 19, 2025
Certification dateNovember 19, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

Other providers in Medford