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PROVIDENCE HEALTH SYSTEM OREGON
NPI 1023098118
Clinic/Center - Multi-Specialty in Portland, OR

Active since January 17, 2006
4540 NE GLISAN ST, PORTLAND, OR 97213(503) 215-3738(503) 215-6942 Get Directions Write a Review

NPPES record last updated: May 16, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 16, 2025, Aug 22, 2020 (2 updates tracked since 2020).

About Providence Health System Oregon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTH SYSTEM OREGON (NPI 1023098118), doing business as Providence Elder Place Portland, is a healthcare organization registered as a multi-specialty in Portland, Oregon and active in the NPI registry since January 2006. The organization lists Donald W Anderson, Assistant Secretary Of Enrollment, as its authorized official.

NPPES Registry Identity

NPI1023098118
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NamePROVIDENCE HEALTH SYSTEM OREGON
Location Address4540 NE GLISAN STPortland, OR 97213-2333
Mailing Address13007 Ne Glisan StPortland, OR 97230-2545 · (503) 215-6556 · Fax (503) 215-0685
Phone(503) 215-3738
Fax(503) 215-6942
Organization SubpartNo
Authorized OfficialDonald W AndersonAssistant Secretary Of Enrollment · (425) 358-9786
Enumeration DateJanuary 17, 2006
Last NPPES UpdateMay 16, 20252 updates tracked since enumeration
NPPES CertifiedMay 16, 2025
✔ NPI 1023098118 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
4540 NE GLISAN ST, Portland, OR 97213
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Other Names 1

Doing Business AsProvidence Elder Place Portland

Other Identifiers 1

Medicaid005673OR

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JACQUELYN ALICE BENNETT RN
Registered Nurse (Gerontology)
4540 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-3738
MS. SUELLEN YOUNG R.N.
Registered Nurse (Community Health)
4540 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-3738
PAMELA A SAITO R.N.
Registered Nurse
4540 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-3738
BARBARA TANNER R.N.
Registered Nurse
4540 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-3738
SUSAN MARIE WETZEL RD LD
Dietitian, Registered
4540 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-5237
KYLE ANDERSON RN, BSN
Registered Nurse (Community Health)
4540 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-3738
LAWRENCE HANBROOK RN
Registered Nurse
4540 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-3738
ORAN KENNETH HIRSCH BSN, RN
Registered Nurse (Case Management)
4540 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (971) 409-7276

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Health System Oregon's NPI number?

The NPI number for Providence Health System Oregon is 1023098118. It was assigned to this organization in the NPPES registry on January 17, 2006. The provider is doing business as Providence Elder Place Portland.

Where is Providence Health System Oregon located?

Providence Health System Oregon is located at 4540 NE Glisan St, Portland, OR 97213. The listed phone number is (503) 215-3738.

What is Providence Health System Oregon's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

When was this NPI record last updated?

The NPPES record for Providence Health System Oregon was last updated on May 16, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.