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	3336L0003X	Long Term Care Pharmacy
2	3336I0012X	Institutional Pharmacy	PHAR355	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1997047	OTHER		PK

General Provider Information

NPI Number	:	1083695324
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 E REZANOF DR
Second Line	:
City	:	KODIAK
State	:	AK
Zip	:	99615-6602
Country	:	US
Telephone Number	:	907-486-9550
Fax Number	:	907-486-9553

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	05/15/2025

Similar Medicare Providers

1750307740 — GREGORY LEROY CULVER MD
Practice Location Address:

1915 E REZANOF DR
KODIAK, AK
99615-6602

Practice Phone: 907-486-3781
Practice Fax: 907-486-9586

1013905660 — PROVIDENCE HEALTH & SERVICES WASHINGTON
Practice Location Address:

1915 E REZANOF DR
KODIAK, AK
99615-6602

Practice Phone: 907-486-3281
Practice Fax: 907-486-9546

1629054374 — PROVIDENCE HEALTH & SERVICES WASHINGTON
Practice Location Address:

1915 E REZANOF DR
KODIAK, AK
99615-6602

Practice Phone: 907-486-9550
Practice Fax:

1922085760 — SCOTT ALLEN CARVER CRNA
Practice Location Address:

1915 E REZANOF DR
KODIAK, AK
99615-6602

Practice Phone: 907-486-3281
Practice Fax: 907-684-0421

1831162825 — MRS. LAURA MARIE WALTERS MD
Practice Location Address:

1911 E REZANOF DR
KODIAK, AK
99615-6602

Practice Phone: 907-481-5000
Practice Fax: 907-481-5030

1265405906 — DR. PAUL VICTOR ZIMMER MD
Practice Location Address:

1911 E REZANOF DR
KODIAK, AK
99615-6602

Practice Phone: 907-481-5000
Practice Fax: 907-481-5030

Directions to “PROVIDENCE HEALTH & SERVICES -WASHINGTON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.