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

Providence Health & Services Oregon

Organization Family Medicine Physician · NPI 1568547503

Providence Health & Services Oregon is a Family Medicine Physician in Medford, Oregon. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
6
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Practice location Address checks out

965 Ellendale Dr
Medford, OR 97504-8215
Phone: (541) 732-6000
Fax: (541) 732-6005
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Internal Medicine Physician Taxonomy 207R00000X
Child & Adolescent Psychiatry Physician Taxonomy 2084P0804X
Geriatric Psychiatry Physician Taxonomy 2084P0805X
Clinic/Center Taxonomy 261Q00000X
Adolescent and Children Mental Health Clinic/Center Taxonomy 261QM0855X

Record details

NPI number1568547503
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Health & Services Oregon
Authorized official Donald Anderson — Assistant Secretary Enrollment · (425) 358-9786
Other names Providence Medical Group South
NPI enumeratedOctober 26, 2006
Last updated in NPPESNovember 19, 2025
Certification dateNovember 19, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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