PROVIDENCE HEALTH & SERVICES - WA (NPI# 1003050709) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003050709 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - WA |
| Other Organization Name | PMG NW WA H P URGENT CARE |
| Practice Address |
4112 Harbour Pointe Blvd Sw Suite100 Mukilteo WA 98275-5457 |
| Mailing Address |
Po Box 34439 Seattle WA 98124-1439 |
| Practice Telephone | 4253476350 |
| Practice Fax Number | 4253476335 |
| Mailing Telephone | 4253165469 |
| Mailing Fax Number | 4253165484 |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2012-03-28 |
| Authorized Official Name | MARCY NICOL (DIRECTOR RCM NWR PHYSICIAN DIVISION) |
| Authorized Official Telephone | 4253170284 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PMG NW WA H P Urgent Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215189808 | Providence Health & Services - Wa | Home Health | 1000 N Argonne Rd, Spokane Valley, WA 99212 | 2008-10-15 |
| 1750783759 | Providence Health & Services - Wa | Pharmacy | 916 Pacific Ave, Everett, WA 98201-4147 | 2014-09-22 |
| 1972927267 | Providence Health & Services - Wa | Emergency Response System Companies | 2731 Wetmore Ave, Suite 500, Everett, WA 98201-3571 | 2014-02-07 |
| 1770877227 | Providence Health & Services - Wa | General Practice | 1830 Bickford Ave, Suite 211, Snohomish, WA 98290-1749 | 2011-06-01 |
| 1639468259 | Providence Health & Services - Wa | Orthopaedic Surgery | 1717 13th St, Suite 401, Everett, WA 98201-1621 | 2011-04-05 |
| 1225335425 | Providence Health & Services - Wa | Surgery | 1330 Rockefeller Ave, Ste 520, Everett, WA 98201-1684 | 2011-02-24 |
| 1649402231 | Providence Health & Services - Wa | Social Worker | 916 Pacific Ave, 7th Floor, Everett, WA 98201-4147 | 2009-08-14 |
| 1861622557 | Providence Health & Services - Wa | Social Worker | 12800 Bothell Everett Hwy, Suite 110, Everett, WA 98208-6642 | 2009-07-16 |
| 1265669451 | Providence Health & Services - Wa | Clinic/Center | 101 W 8th Ave, Women's Health Center, Spokane, WA 99204-2307 | 2009-06-16 |
| 1669616363 | Providence Health & Services - Wa | Family Medicine | 4112 Harbour Pointe Blvd Sw, Suite 100, Mukilteo, WA 98275-5457 | 2009-04-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Health & Services - Washington | 1801 Lind Ave. Sw, #9016, Renton, WA 98057 |
| Street Address |
4112 HARBOUR POINTE BLVD SW SUITE100 |
| City | MUKILTEO |
| State | WA |
| Zip Code | 98275-5457 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760474738 | Chiyang Wu | Family Medicine | 4112 Harbour Pointe Blvd Sw, Suite 100, Mukilteo, WA 98275-5457 | 2005-08-16 |
| 1144662008 | Rolana O Mesias | Registered Nurse | 4112 Harbour Pointe Blvd Sw, Suite 100, Mukilteo, WA 98275-5457 | 2013-07-20 |
| 1467728964 | Sabrina Middleton | Pediatrics | 4112 Harbour Pointe Blvd Sw, Ste 100, Mukilteo, WA 98275-5457 | 2012-03-29 |
| 1639481500 | Dean Nair | Family Medicine | 4112 Harbour Pointe Blvd Sw, Suite 100, Mukilteo, WA 98275-5457 | 2010-07-08 |
| 1669616363 | Providence Health & Services - Wa | Family Medicine | 4112 Harbour Pointe Blvd Sw, Suite 100, Mukilteo, WA 98275-5457 | 2009-04-24 |
| 1124279237 | Providence Health & Services - Wa | Internal Medicine | 4112 Harbour Pointe Blvd Sw, Suite 100, Mukilteo, WA 98275-5457 | 2008-10-07 |
| 1700037199 | Providence Health & Services-wa | Clinic/Center | 4112 Harbour Pointe Blvd Sw, Suite 100, Mukilteo, WA 98275-5457 | 2008-10-04 |
| 1366602468 | Poonam Rauniyar | Pediatrics | 4112 Harbour Pointe Blvd Sw, Ste 100, Mukilteo, WA 98275-5457 | 2008-06-11 |
| 1568644607 | Rajasri Dharani Palepu | Internal Medicine | 4112 Harbour Pointe Blvd Sw, Mukilteo, WA 98275-5457 | 2007-11-30 |
| 1225111867 | Darrell Eugene Cline | Dentist | 4112 Harbour Pointe Blvd Sw, Suite 200, Mukilteo, WA 98275 | 2006-10-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477030245 | Brandon Eugene Moore | Social Worker | 12303 Cyrus Way, Suite 107, Mukilteo, WA 98275 | 2018-07-25 |
| 1407349962 | Cascade Endocrinology Pllc | Internal Medicine | 8423 Mukilteo Spdwy Ste 102, Mukilteo, WA 98275 | 2018-06-10 |
| 1780059899 | Jamie Kowatch | Dietitian, Registered | 8423 Mukilteo Speedway Ste 102, Mukilteo, WA 98275 | 2015-12-01 |
| 1225479025 | Helen Ra | Pharmacist | 5600 Harbour Pointe Blvd., Unit 1-105, Mukilteo, WA 98275 | 2013-07-10 |
| 1861731333 | Lynn Sharon Schmidt | Physical Therapist | 10520 Harbour Pointe Blvd, Columbia Elementary School - Msd #6, Mukilteo, WA 98275 | 2013-02-04 |
| 1023318326 | Hillary E Hofstaedter | Registered Nurse | 10710 Mukilteo Speedway # 67, Mukilteo, WA 98275 | 2010-11-02 |
| 1528371416 | Zita Molnar Fekete | Counselor | 4460 73rd Pl Sw, Mukilteo, WA 98275 | 2010-07-20 |
| 1497900609 | Heidi S. Rendall | Family Medicine | 8227 44th Ave W., Ste E, Mukilteo, WA 98275 | 2008-12-02 |
| 1558583609 | Ana B Rountree | Physician Assistant | 10710 Mukilteo Spdwy, Mukilteo, WA 98275 | 2007-05-02 |
| 1376769752 | Wahid Elbahr | Dentist | 12121 Harbour Reach Dr., Ste 210, Mukilteo, WA 98275 | 2007-04-17 |
| Find all providers in zip 98275 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063971703 | Source Northwest Integrative Medicine | General Practice | 7206 267th St Nw Ste 102, Stanwood, WA 98292-6269 | 2019-03-12 |
| 1255896601 | Emily Christine Buck | General Practice | 940 Fitzsimmons Dr, Tacoma, WA 98431-0001 | 2019-02-08 |
| 1740755651 | Alyssa Ann Yruegas | General Practice | 2108 W Spruce St, Moses Lake, WA 98837-2853 | 2018-10-06 |
| 1306321237 | Rainier Springs Physician Group, LLC | General Practice | 2805 Ne 129th Street, Vancouver, WA 98686 | 2018-09-26 |
| 1962916437 | Parkview Medical Group Inc | General Practice | 615 S Division St Ste A, Moses Lake, WA 98837-3800 | 2017-11-20 |
| 1790212496 | Thien Thanh Ho | General Practice | 12307 Douglas Rd, Yakima, WA 98908-9129 | 2017-05-12 |
| 1285173625 | Regenerative Medicine Institute, Pllc | General Practice | 731 N Stanley St, Medical Lake, WA 99022-8940 | 2017-02-17 |
| 1457708430 | James Bailey | General Practice | 9040 Jackson Ave Tripler Army Medical Center, Tacoma, WA 98431-5001 | 2016-05-19 |
| 1740635887 | Peter Chulhi Kang | General Practice | 1425 Spring St Apt 802, Seattle, WA 98104-1635 | 2016-04-26 |
| 1831551084 | Anna Hackenmiller | General Practice | 1657 S Nettleton Ln, Spokane, WA 99224-6108 | 2016-03-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.