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PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1235595299
Internal Medicine - Cardiovascular Disease in Ilwaco, WA

Active since January 06, 2016
174 1ST AVE N, ILWACO, WA 98624(503) 717-7850(503) 216-0775 Get Directions Write a Review

NPPES record last updated: July 4, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 4, 2025, May 16, 2025 (2 updates tracked since 2025).

About Providence Health & Services - Oregon NPPES

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

PROVIDENCE HEALTH & SERVICES - OREGON (NPI 1235595299), doing business as Providence Medical Group, is a healthcare organization registered as a cardiovascular disease in Ilwaco, Washington and active in the NPI registry since January 2016. The organization lists Donald Wayne Anderson, Assistant Secreatry For Enrollment, as its authorized official.

NPPES Registry Identity

NPI1235595299
Entity TypeOrganization
Primary Taxonomy207RC0000X
Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON
Location Address174 1ST AVE NIlwaco, WA 98624-9137
Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180
Phone(503) 717-7850
Fax(503) 216-0775
Organization SubpartNo
Authorized OfficialDonald Wayne AndersonAssistant Secreatry For Enrollment · (425) 358-9786
Enumeration DateJanuary 6, 2016
Last NPPES UpdateJuly 4, 20252 updates tracked since enumeration
NPPES CertifiedJuly 4, 2025
✔ NPI 1235595299 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RC0000X
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Also ListedClinic/CenterTaxonomy 261Q00000X
174 1ST AVE N, Ilwaco, WA 98624
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Other Names 2

Doing Business AsProvidence Medical Group
Doing Business AsProvidence St Vincent Heart Care Clinic Ilwaco

Other Providers at the Same Location NPPES 13

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

ANDREW CLIFFORD LAKANEN MS, RDN, LD
Dietitian, Registered
174 1ST AVE N
ILWACO, WA 98624
Pacific County (360) 642-6314
MS. DENISE ROSS RN-CDE
Registered Nurse (Diabetes Educator)
174 1ST AVE N
ILWACO, WA 98624
Pacific County (360) 642-3181
MS. GLORIA VANDEHEY RN-CDE
Registered Nurse (Diabetes Educator)
174 1ST AVE N
ILWACO, WA 98624
Pacific County (360) 642-3181
DANIELLE MEYEN
Physician Assistant
174 1ST AVE N
ILWACO, WA 98624
Pacific County (360) 642-3181
DR. DANIEL RAYMOND SHAMIR
Physical Therapist
174 1ST AVE N
ILWACO, WA 98624
Pacific County (360) 642-3181
MR. WILLIAM G CHISHOLM JR. CRNA
Nurse Anesthetist, Certified Registered
174 1ST AVE N
ILWACO, WA 98624
Pacific County (360) 642-3181
VAUGHAN GENDELMAN DPT
Physical Therapist
174 1ST AVE N
ILWACO, WA 98624
Pacific County (360) 642-6328
LIN LI
Social Worker
174 1ST AVE N
ILWACO, WA 98624
Pacific County (360) 642-3181

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 1235595299. It was assigned to this organization in the NPPES registry on January 6, 2016. The provider is doing business as Providence Medical Group and Providence St Vincent Heart Care Clinic Ilwaco.

Where is Providence Health & Services - Oregon located?

Providence Health & Services - Oregon is located at 174 1st Ave N, Ilwaco, WA 98624. The listed phone number is (503) 717-7850.

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

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

When was this NPI record last updated?

The NPPES record for Providence Health & Services - Oregon was last updated on July 4, 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.