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PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1083963573
Otolaryngology in The Dalles, OR

Active since August 30, 2012
1815 E 19TH ST, SUITE 1, THE DALLES, OR 97058(541) 298-5563 Get Directions Write a Review

NPPES record last updated: June 20, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 20, 2025, May 16, 2025, Jan 15, 2021 (3 updates tracked since 2021).

About Providence Health & Services - Oregon NPPES

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

PROVIDENCE HEALTH & SERVICES - OREGON (NPI 1083963573), doing business as Providence Medical Group, is a healthcare organization registered as an otolaryngology in The Dalles, Oregon and active in the NPI registry since August 2012. The organization lists Donald W Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1083963573
Entity TypeOrganization
Primary Taxonomy207Y00000X
Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON
Location Address1815 E 19TH ST, SUITE 1The Dalles, OR 97058-3385
Mailing AddressPo Box 31001-4180Pasadena, CA 91110-4118
Phone(541) 298-5563
Organization SubpartNo
Authorized OfficialDonald W AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateAugust 30, 2012
Last NPPES UpdateJune 20, 20253 updates tracked since enumeration
NPPES CertifiedJune 20, 2025
✔ NPI 1083963573 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians
Taxonomy Code207Y00000X
Definition
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
Also ListedClinic/CenterTaxonomy 261Q00000X
1815 E 19TH ST, The Dalles, OR 97058
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Other Names 2

Doing Business AsProvidence Medical Group
Doing Business AsProvidence The Dalles Ent

Other Identifiers 1

Medicaid500650976OR

Other Providers at the Same Location NPPES 5

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

JAMES PATRICK PETRUSICH DOCTOR OF AUDIOLOGY
Audiologist
1815 E 19TH ST, SUITE 1
THE DALLES, OR 97058
Wasco County (541) 298-8676
MR. JAMES L FERRER
Hearing Instrument Specialist
1815 E 19TH ST
THE DALLES, OR 97058
Wasco County (541) 298-8676
COLUMBIA GORGE ENT, LLC
Otolaryngology
1815 E 19TH ST, SUITE 1
THE DALLES, OR 97058
Wasco County (541) 298-5563
DR. CHARLES R FORD MD
Otolaryngology
1815 E 19TH ST, SUITE 1
THE DALLES, OR 97058
Wasco County (541) 298-5563
MATTHEW DAVID PROCTOR MD
Otolaryngology
1815 E 19TH ST, STE 1
THE DALLES, OR 97058
Wasco County (541) 298-5563

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 & Services - Oregon's NPI number?

The NPI number for Providence Health & Services - Oregon is 1083963573. It was assigned to this organization in the NPPES registry on August 30, 2012. The provider is doing business as Providence Medical Group and Providence The Dalles ENT.

Where is Providence Health & Services - Oregon located?

Providence Health & Services - Oregon is located at 1815 E 19th St Suite 1, The Dalles, OR 97058. The listed phone number is (541) 298-5563.

What is Providence Health & Services - Oregon's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

When was this NPI record last updated?

The NPPES record for Providence Health & Services - Oregon was last updated on June 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.