Healthcare Provider Details

I. General information

NPI: 1972927267
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 WETMORE AVE SUITE 500
EVERETT WA
98201-3571
US

IV. Provider business mailing address

PO BOX 94349
SEATTLE WA
98124-6649
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4800
  • Fax: 425-261-4819
Mailing address:
  • Phone: 425-261-4800
  • Fax: 425-261-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: DONALD W ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENT
Credential:
Phone: 425-358-9786