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	261QX0100X	Occupational Medicine Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1952500209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES WASHINGTON

Provider Business Mailing Address
First Line	:	PO BOX 31001 - 4110
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4110
Country	:	US
Telephone Number	:	425-525-6778
Fax Number	:	425-525-6700

Provider Business Practice Location Address
First Line	:	1800 COOKS HILL RD
Second Line	:	SUITE E
City	:	CENTRALIA
State	:	WA
Zip	:	98531-9072
Country	:	US
Telephone Number	:	360-330-8626
Fax Number	:	360-807-7983

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	03/03/2026

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Directions to “PROVIDENCE HEALTH & SERVICES WASHINGTON ” Practice Location

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