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General NPI Number Information
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NPI Number | 1699926402
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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 | 10/10/2008
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 401 W POPLAR ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-2846
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Country | US
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Telephone | 509-522-5802
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Fax | 509-522-5541
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4114
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City | PASADENA
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State | CA
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Zip | 91110-4114
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Country | US
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Telephone | 509-522-5906
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Fax | 509-522-5789
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | H-050
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License Number State | WA
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