Healthcare Provider Details

I. General information

NPI: 1508000142
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: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CHASE AVE
WALLA WALLA WA
99362-2924
US

IV. Provider business mailing address

209 W POPLAR ST PO BOX 1477
WALLA WALLA WA
99362-2828
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-5171
  • Fax: 509-522-5899
Mailing address:
  • Phone: 509-522-5906
  • Fax: 509-522-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberHAC.FS.00000050
License Number StateWA

VIII. Authorized Official

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