Healthcare Provider Details

I. General information

NPI: 1508118555
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICE- WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204
US

IV. Provider business mailing address

PO BOX 94645
SEATTLE WA
98124-6945
US

V. Phone/Fax

Practice location:
  • Phone: 855-600-5163
  • Fax:
Mailing address:
  • Phone: 855-394-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

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