Healthcare Provider Details

I. General information

NPI: 1326282963
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W POPLAR ST SUITE 210
WALLA WALLA WA
99362-2858
US

IV. Provider business mailing address

PO BOX 31001 - 4110
PASADENA CA
91110-4110
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-5825
  • Fax: 509-529-3512
Mailing address:
  • Phone: 509-522-5906
  • Fax: 509-522-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberHAC.FS00000050
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberHAC.FS.00000050
License Number StateWA

VIII. Authorized Official

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