PROVIDENCE HEALTH & SERVICES WASHINGTON


Address: 420 Golf Club Rd Se, Suite 203, Lacey, WA 98503-1048
Phone: 3604937469

PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI# 1063611408) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1063611408
Entity Type Organization
Organization Name PROVIDENCE HEALTH & SERVICES WASHINGTON
Practice Address 420 Golf Club Rd Se
Suite 203
Lacey
WA 98503-1048
Mailing Address Po Box 3505
Portland
OR 97208-3505
Practice Telephone 3604937469
Practice Fax Number 3604592023
Mailing Telephone 4255256717
Mailing Fax Number 4255256700
Enumeration Date 2007-07-16
Last Update Date 2017-10-31
Authorized Official Name DONALD WAYNE ANDERSON JR. (DIRECTOR REIMBURSEMENT ADMINISTRATI)
Authorized Official Telephone 4255255392
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261Q00000X Clinic/Center H-159 WA Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
WA L&I 129210 01
WA 7115611 05
WA L&I CRIME VICTIMS 8919875 01

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1134656135 Providence Health & Services Washington Clinic/Center 1018 Capitol Way S Ste 300, Olympia, WA 98501-1212 2017-05-22
1023550050 Providence Health & Services Washington Psychologist 225 State Ave Ne, Olympia, WA 98501-6951 2016-11-08
1003367863 Providence Health & Services Washington Radiology 4800 College St Se Ste E, Lacey, WA 98503-4389 2016-10-17
1023563897 Providence Health & Services Washington Clinic/Center 1705 Se Meadowbrook Blvd, Suite 2, College Place, WA 99324-1756 2016-08-22
1457721250 Providence Health & Services Washington Clinic/Center 1200 Basich Blvd, Aberdeen, WA 98520-1035 2015-10-06
1902141500 Providence Health & Services Washington Clinical Medical Laboratory 820 S Mcclellan St Ste Ll10, Spokane, WA 99204-2446 2012-12-07
1881907715 Providence Health & Services Washington Internal Medicine 62 W 7th Ave, Spokane, WA 99204-2321 2010-07-20
1073744850 Providence Health & Services Washington Rehabilitation, Substance Use Disorder Unit 2505 Olympic Hwy N., Ste 140, Shelton, WA 98584-2978 2009-07-28
1770714693 Providence Health & Services Washington Rehabilitation, Substance Use Disorder Unit 508 1/2 Eighth Street, Hoquiam, WA 98550-3521 2009-07-28
1033309604 Providence Health & Services Washington Family Medicine 1450 Northwest Lane Se, Lacey, WA 98503-6908 2007-07-30

Office Location

Street Address 420 GOLF CLUB RD SE
SUITE 203
City LACEY
State WA
Zip Code 98503-1048

Providers in the same location

NPI Name Taxonomy Address Enumeration
1225128986 Deborah K. Hall Pediatrics 420 Golf Club Rd Se, Suite 204, Lacey, WA 98503-1048 2006-10-13
1457640492 Tambra Lin Donohue Psychologist 420 Golf Club Rd Se, Lacey, WA 98503-1048 2011-03-30
1518153949 Lisa Gail Wahl Nurse Practitioner 420 Golf Club Rd Se, Suite 204, Lacey, WA 98503-1048 2007-09-19
1235264177 Judith Presson Registered Nurse 420 Golf Club Rd Se, Suite 203, Lacey, WA 98503-1048 2007-02-22
1477633659 Laurie J. Davis Nurse Practitioner 420 Golf Club Rd Se, Suite 204, Lacey, WA 98503-1048 2006-10-16

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1457838989 Michele Nordgren Bourque Psychologist 4329 Concordia Lane Se, Lacey, WA 98503 2018-07-26
1831638675 Trevor John Marum Chiropractor 3945 8th Ave Se, Lacey, WA 98503 2017-02-13
1366993362 Vanessa Julie Iglesias Mehta Physician Assistant 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 2016-10-14
1144683616 Millenda Thomas Registered Nurse 1233 Firpark Dr. S.e., Lacey, WA 98503 2016-04-01
1609257245 Erika Charlotte Vonkotzebue Counselor 4401 37th Ave. Se #25, Lacey, WA 98503 2015-06-09
1437576196 Candy Nelson Registered Nurse 4410 6th Ave Se, Apt# 115, Lacy, WA 98503 2014-03-19
1134563919 Alvin Fitzgerald Pharmacist 665 Sleater Kinney Rd., S.e, Target Pharmacy #1355, Lacey, WA 98503 2013-04-23
1518200724 Katherine Mary Marsh Psychologist 5191 Corporate Center Court Se, Lacey, WA 98503 2013-04-05
1740530906 Leanna Marie Mcbroom Massage Therapist 1608 Diamond Loop Se, Lacey, WA 98503 2012-09-14
1831445196 Joyce Emily Christensen Coniff Counselor 5706 39th Ave Se., Lacey, WA 98503 2012-07-24
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Taxonomy Information

Taxonomy Code 261Q00000X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center

Taxonomy Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1801450952 Washington Center for Pain Management Pllc Clinic/Center 5602 Ruddell Rd Se Ste A, Lacey, WA 98503-5163 2019-04-24
1215431697 Providence Health & Services Washington Clinic/Center 4800 College St Se, Lacey, WA 98503-4389 2018-03-21
1013453554 Fitness Recovery Room LLC Clinic/Center 8830 Tallon Ln Ne, F, Lacey, WA 98516-6656 2017-01-09
1801211255 New Leaf Hyperbarics Olympia Clinic/Center 8730 Tallon Ln Ne, Suite 104, Lacey, WA 98516-6609 2014-02-21
1235464850 Khy Optometry & Associates, Pllc Clinic/Center 1350 Marvin Rd Ne Ste D, Lacey, WA 98516-3877 2009-10-15

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1407457153 Scandia Wellness Clinic/Center 121 Naylor Rd, Mossyrock, WA 98564-9507 2020-11-07
1699376152 Seattle Vision Therapy and Rehabilitation Center, Pllc Clinic/Center 13344 1st Ave Ne Ste 101, Seattle, WA 98125-3059 2020-11-02
1942811211 Little Fin Therapies, LLC Clinic/Center 5942 31st Ave Sw, Seattle, WA 98126-2910 2020-08-11
1578187829 Therapy Northwest Pllc Clinic/Center 310 3rd Ave Ne Ste 124, Issaquah, WA 98027-3350 2020-06-02
1922621721 Riaz Pllc Clinic/Center 8378 W Grandridge Blvd Ste 110, Kennewick, WA 99336-5401 2020-05-27
1295356848 Community Health Care Clinic/Center 16329 Se 318th St, Auburn, WA 98092-9284 2020-05-05
1720617533 Nova Mind-body LLC Clinic/Center 116 13th Ave E Apt 1e, Seattle, WA 98102-6142 2020-04-03
1609403054 Lavender Luxe Massage Clinic/Center 100 3rd St Ste 100, Davenport, WA 99122-5008 2020-03-25
1417582255 Personalized Health, LLC Clinic/Center 7136 Mlk Jr Way S Ste 204, Seattle, WA 98118-3526 2020-03-11
1912530932 Lummi Indian Business Council Clinic/Center 2924 Haxton Way, Bellingham, WA 98226-9265 2020-02-18
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Competitor

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City LACEY
Zip Code 98503

Improve Information

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Dataset Information

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.

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