NPI Code Detail JSON Logo

1720121346 NPI number — PROVIDENCE HEALTH & SERVICES WASHINGTON

NPI Number: 1720121346
Health Care Provider/Practitioner: PROVIDENCE HEALTH & SERVICES WASHINGTON

Information about “1720121346” NPI (PROVIDENCE HEALTH & SERVICES WASHINGTON) exists in 1720121346 in HTML format HTML  |  1720121346 in plain Text format TXT  |  1720121346 in PDF (Portable Document Format) PDF  |  1720121346 in an XML format XML  formats.

NPI Number : 1720121346 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720121346",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 24292",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEATTLE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98124-0292",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "425-687-4400",
    "MailingAddressFaxNumber": "425-687-4401",
    "FirstLinePracticeLocationAddress": "3333 S 120TH PL STE 100B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TUKWILA",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98168-5134",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "425-687-4400",
    "PracticeLocationAddressFaxNumber": "425-687-4401",
    "EnumerationDate": "02/14/2007",
    "LastUpdateDate": "05/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ANDERSON",
    "AuthorizedOfficialFirstName": "DONALD",
    "AuthorizedOfficialMiddleName": "W",
    "AuthorizedOfficialTitle": "ASSISTANT SECRETARY OF ENROLLMENTS",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": "JR.",
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "425-358-9786",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208U00000X",
          "TaxonomyName": "Clinical Pharmacology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0002X",
          "TaxonomyName": "Clinic Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336H0001X",
          "TaxonomyName": "Home Infusion Therapy Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336L0003X",
          "TaxonomyName": "Long Term Care Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336M0003X",
          "TaxonomyName": "Managed Care Organization Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336L0003X",
          "TaxonomyName": "Long Term Care Pharmacy",
          "LicenseNumber": "CF00056548",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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