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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
11041C0700XClinical Social Worker297340AK
2171M00000XCase Manager/Care Coordinator297340AK
32084P0800XPsychiatry Physician297340AK
4101YA0400XAddiction (Substance Use Disorder) Counselor297340AK
5251S00000XCommunity/Behavioral Health Agency297340AK

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 : 1477563344
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE HEALTH & SERVICES WASHINGTON
Provider Business Mailing Address
First Line : PO BOX 3290
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3290
Country : US
Telephone Number : 907-486-9500
Fax Number :
Provider Business Practice Location Address
First Line : 1818 E REZANOF DR
Second Line :
City : KODIAK
State : AK
Zip : 99615-6505
Country : US
Telephone Number : 907-481-2400
Fax Number : 907-481-2419
Authorized Official
Title or Position : ASSISTANT SECRETARY OF ENROLLMENTS
Name : MR. DONALD WAYNE ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 08/09/2006
Last Update Date : 05/15/2025

Similar Medicare Providers

1376334847 — MEGAN IVANOFF MHPC
Practice Location Address:
1818 E REZANOF DR
KODIAK, AK
99615-6505
Practice Phone: 907-481-2400
Practice Fax:
1093788994 — RAE JEAN BLASCHKA NP
Practice Location Address:
1818 E REZANOF DR
KODIAK, AK
99615-6505
Practice Phone: 907-486-6065
Practice Fax: 907-486-2248
1891901187 — MS. ESTHER ABIGAIL BOLD MA, LPC, LADC
Practice Location Address:
1818 E REZANOF DR
KODIAK, AK
99615-6505
Practice Phone: 405-757-7696
Practice Fax:
1952567828 — BELINDA K CHAMBERS MS, RD, LCSW
Practice Location Address:
1818 E REZANOF DR
KODIAK, AK
99615-6505
Practice Phone: 907-481-2400
Practice Fax:
1598225351 — CAROLYN CLAIRE CRAIG MD
Practice Location Address:
1818 E REZANOF DR
KODIAK, AK
99615-6505
Practice Phone: 907-481-2400
Practice Fax: 907-481-2419
1790439966 — DEBBIE-LYNN H GIBSON LMSW
Practice Location Address:
1818 E REZANOF DR
KODIAK, AK
99615-6505
Practice Phone: 907-481-2432
Practice Fax:

Directions to “PROVIDENCE HEALTH & SERVICES WASHINGTON ” Practice Location

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