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	305R00000X	Preferred Provider Organization	HAC.FS.00000050	WA

General Provider Information

NPI Number	:	1982848057
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	:	509-522-5906
Fax Number	:	509-522-5789

Provider Business Practice Location Address
First Line	:	380 CHASE AVE
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2924
Country	:	US
Telephone Number	:	509-526-3333
Fax Number	:	509-522-5789

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

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	03/06/2026

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

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