MEDICARE: PROVIDENCE HEALTH & SERVICES WASHINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC0060X	Critical Access Hospital	309115	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013905660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES WASHINGTON

Provider Business Mailing Address
First Line	:	PO BOX 3706
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3706
Country	:	US
Telephone Number	:	907-486-3281
Fax Number	:	907-486-9546

Provider Business Practice Location Address
First Line	:	1915 E REZANOF DR
Second Line	:
City	:	KODIAK
State	:	AK
Zip	:	99615-6602
Country	:	US
Telephone Number	:	907-486-3281
Fax Number	:	907-486-9546

Authorized Official
Title or Position	:	ASSISTANT SECRETARY OF ENROLLMENTS
Name	:	DONALD WAYNE ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	05/13/2025

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Directions to “PROVIDENCE HEALTH & SERVICES WASHINGTON ” Practice Location

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