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General NPI Number Information
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NPI Number | 1457721250
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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 | 10/06/2015
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1200 BASICH BLVD
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City | ABERDEEN
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State | WA
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Zip | 98520-1035
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Country | US
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Telephone | 360-537-8801
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Fax | 360-537-8782
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4110
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City | PASADENA
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State | CA
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Zip | 91110-4110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY FOR ENROLLMENT
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Name | MR. DONALD WAYNE 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 | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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