PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI# 1215431697) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215431697 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES WASHINGTON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP SW WA - MDPP |
| Practice Address |
4800 College St Se Lacey WA 98503-4389 |
| Practice Telephone | 3604937567 |
| Practice Fax Number | 3604126468 |
| Mailing Telephone | 3604937567 |
| Mailing Fax Number | 3604126468 |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2018-03-21 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASST CORP SECRETARY - ENROLLMENT) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Providence Medical Group SW WA - MDPP | Doing Business As Name - Organization |
| 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 |
| Street Address |
4800 COLLEGE ST SE |
| City | LACEY |
| State | WA |
| Zip Code | 98503-4389 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457339319 | Sandra Loyer | Physician Assistant | 4800 College St Se, Lacey, WA 98503-4389 | 2006-01-02 |
| 1114568540 | Karen Lee Newman | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2019-10-07 |
| 1124674965 | Michaela Jane De Groot | Physical Therapist | 4800 College St Se, Lacey, WA 98503-4389 | 2019-08-16 |
| 1912475666 | Andrew Thomas | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2018-11-09 |
| 1487151577 | Tana Russell | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2018-04-06 |
| 1194229732 | Joanne Marie Mulder | Physician Assistant | 4800 College St Se, Lacey, WA 98503 | 2018-03-20 |
| 1467986802 | Danilynn Benavente | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-04-12 |
| 1245761675 | Sophia Stanley | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-03-27 |
| 1992236814 | Virginia Harris | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-03-22 |
| 1942731872 | Becky Baker | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-03-22 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 98503 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| 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). |
| 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 |
| 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 |
| 1063611408 | Providence Health & Services Washington | Clinic/Center | 420 Golf Club Rd Se, Suite 203, Lacey, WA 98503-1048 | 2007-07-16 |
| 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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| 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.