OrganizationActive
Providence Health & Services - Oregon
NPI 1235595299 · Cardiovascular Disease Physician · Ilwaco, WA
Provider details
- NPI number
- 1235595299
- Entity type
- Organization
- Primary specialty
- Cardiovascular Disease PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Donald Anderson, Assistant Secreatry for Enrollment(425) 358-9786
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Clinic/Center261Q00000X
Ambulatory Health Care Facilities
Profile Score
Established profile(72/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
174 1st Ave N
Ilwaco, WA 98624-9137
Phone: (503) 717-7850
Fax: (503) 216-0775
Street-level locationGet directions
Mailing address
Po Box 31001 - 4180
Pasadena, CA 91110-4180
Other names (DBA / former)
- Doing business as
- Providence Medical Group
- Doing business as
- Providence St Vincent Heart Care Clinic Ilwaco
Registry dates
- Enumerated
- 2016-01-06
- Last updated
- 2025-07-04
- Certified
- 2025-07-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.