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
1	207R00000X	Internal Medicine Physician
2	208600000X	Surgery Physician
3	207X00000X	Orthopaedic Surgery Physician
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1326569682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES - WASHINGTON

Provider Business Mailing Address
First Line	:	PO BOX 31001 - 4110
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 CHASE AVE
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2924
Country	:	US
Telephone Number	:	509-526-3333
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY FOR ENROLLMENT
Name	:	DONALD WAYNE ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	03/03/2026

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Directions to “PROVIDENCE HEALTH & SERVICES - WASHINGTON ” Practice Location

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