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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1902141500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES WASHINGTON

Provider Business Mailing Address
First Line	:	PO BOX 31001-4114
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S MCCLELLAN ST STE LL10
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99204-2446
Country	:	US
Telephone Number	:	509-353-4260
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY OF ENROLLMENTS
Name	:	DONALD W. ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	05/05/2025

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