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NPI Code Detail

MEDICARE: PROVIDENCE HEALTH & SERVICES WASHINGTON

MEDICARE: PROVIDENCE HEALTH & SERVICES WASHINGTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health AgencyWA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063524346
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE HEALTH & SERVICES WASHINGTON
Provider Business Mailing Address
First Line : 2811 S 102ND ST
Second Line :
City : TUKWILA
State : WA
Zip : 98168-1870
Country : US
Telephone Number : 425-525-6800
Fax Number : 425-525-6825
Provider Business Practice Location Address
First Line : 2811 S 102ND ST
Second Line :
City : TUKWILA
State : WA
Zip : 98168-1870
Country : US
Telephone Number : 425-525-6800
Fax Number : 425-525-6825
Authorized Official
Title or Position : ASSISTANT SECRETARY OF ENROLLMENT
Name : MR. DONALD WAYNE ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 08/31/2006
Last Update Date : 05/06/2025

Similar Medicare Providers

1821099672 — DR. BRUCE CAMERON SMITH M.D.
Practice Location Address:
2811 S 102ND ST
TUKWILA, WA
98168-1870
Practice Phone: 206-320-4000
Practice Fax:
1124395819 — DR. JON SIMON MAYO P.T., D.P.T.
Practice Location Address:
2811 S 102ND ST
TUKWILA, WA
98168-1870
Practice Phone: 425-525-6800
Practice Fax:
1992349674 — TENECHI HOWARD
Practice Location Address:
2811 S 102ND ST
TUKWILA, WA
98168-1870
Practice Phone: 425-525-6800
Practice Fax:
1639948276 — MARTIN ARREDONDO PEREZ
Practice Location Address:
2811 S 102ND ST , SUITE 220
TUKWILA, WA
98168-1870
Practice Phone: 425-525-6800
Practice Fax:
1457120099 — JESSICA N MARTIN
Practice Location Address:
2811 S 102ND ST , SUITE 220
TUKWILA, WA
98168-1870
Practice Phone: 425-525-6800
Practice Fax:
1366211906 — BLAISE KENNETH SMITH
Practice Location Address:
2811 S 102ND ST , SUITE 220
TUKWILA, WA
98168-1870
Practice Phone: 425-525-6800
Practice Fax:

Directions to “PROVIDENCE HEALTH & SERVICES WASHINGTON ” Practice Location

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