Healthcare Provider Details

I. General information

NPI: 1265669451
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE WOMEN'S HEALTH CENTER
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

PO BOX 2555 WOMEN'S HEALTH CENTER
SPOKANE WA
99220-2555
US

V. Phone/Fax

Practice location:
  • Phone: 877-474-2400
  • Fax: 509-474-3129
Mailing address:
  • Phone: 877-474-2400
  • Fax: 509-474-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECREATRY FOR ENROLLMENT
Credential:
Phone: 425-358-9786