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General NPI Number Information
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NPI Number | 1285687749
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 3333 S 120TH PL SUITE 10
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City | TUKWILA
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State | WA
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Zip | 98168-5134
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Country | US
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Telephone | 425-687-4400
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Fax | 425-687-4401
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Provider Business Mailing Address
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Address Line | 3333 S 120TH PL SUITE 100
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City | TUKWILA
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State | WA
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Zip | 98168-5134
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Country | US
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Telephone | 425-687-4400
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Fax | 425-687-4401
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208U00000X
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Taxonomy Name | Clinical Pharmacology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PHAR.CF.60389608
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License Number State | WA
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