PROVIDENCE HEALTH & SERVICES - WASHINGTON (NPI# 1275785669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275785669 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Other Organization Name | PROVIDENCE PHYSICIAN GROUP DEXASCAN PHCC |
| Practice Address |
12800 Bothell Everett Hwy Suite 260b Everett WA 98208-6642 |
| Mailing Address |
909 N Broadway Pbo/credentialing Everett WA 98201-1409 |
| Practice Telephone | 4253165425 |
| Practice Fax Number | 4253165427 |
| Mailing Telephone | 4253170246 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2008-10-16 |
| Authorized Official Name | JOYCE A KOBAYASHI (DIR REVENUE CYCLE MGMT NWSA) |
| Authorized Official Telephone | 4253170186 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
Allopathic & Osteopathic Physicians | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 2471B0102X |
Radiologic Technologist Specialization: Bone Densitometry |
Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OLD NPI | 1093896854 | 01 |
| Other Name | Type Code |
|---|---|
| Providence Physician Group Dexascan PHCC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407162571 | Providence Health & Services - Washington | Internal Medicine | 510 E Amende Drive, Odessa, WA 99159-0000 | 2010-08-26 |
| 1841503034 | Providence Health & Services - Washington | Family Medicine | 18313 Paulsonst Sw, Suite A, Rochester, WA 98579-9262 | 2010-07-16 |
| 1083947709 | Providence Health & Services - Washington | Hospice Care, Community Based | 2731 Wetmore Ave Ste 500, Everett, WA 98201-3585 | 2009-09-14 |
| 1760636690 | Providence Health & Services - Washington | Neurological Surgery | 301 W Poplar Street, Ste 220, Walla Walla, WA 99362-2800 | 2008-11-05 |
| 1558512368 | Providence Health & Services - Washington | Home Health | 209 W Poplar St, Walla Walla, WA 99362 | 2008-10-10 |
| 1922259738 | Providence Health & Services - Washington | Internal Medicine | 380 Chase Avenue, Pmg Se Wa, Walla Walla, WA 99362-2924 | 2008-10-10 |
| 1306097126 | Providence Health & Services - Washington | Radiology | 401 W Poplar Street, Pmg Se Wa Imaging, Walla Walla, WA 99362-2846 | 2008-10-10 |
| 1043374119 | Providence Health & Services - Washington | Rehabilitation, Substance Use Disorder Unit | 508 Quarter Eighth Street, Hoquiam, WA 98550 | 2006-12-21 |
| 1073677605 | Providence Health & Services - Washington | Rehabilitation, Substance Use Disorder Unit | 506 W Franklin St, Shelton, WA 98584-3517 | 2006-12-20 |
| 1003906918 | Providence Health & Services - Washington | Home Health | 3432 Bay Rd Ne, Olympia, WA 98506-2958 | 2006-10-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Health & Services - Washington | 1801 Lind Ave. Sw, #9016, Renton, WA 98057 |
| Street Address |
12800 BOTHELL EVERETT HWY SUITE 260B |
| City | EVERETT |
| State | WA |
| Zip Code | 98208-6642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518963404 | James Daniel Bass | Family Medicine | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2005-06-24 |
| 1437620499 | Laboratory Corporation of America | Clinical Medical Laboratory | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2018-12-16 |
| 1306375563 | Coreyanne L Griffin | Counselor | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-06-09 |
| 1407389448 | Bushra Rahman | Internal Medicine | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-04-06 |
| 1831639731 | Providence Health & Services | Home Health Aide | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2017-02-27 |
| 1700325826 | Caroline Judd | Social Worker | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-02-22 |
| 1225485550 | Amy Barrows | Nurse Practitioner | 12800 Bothell Everett Hwy, Suite 120, Everett, WA 98208-6642 | 2016-05-17 |
| 1104299601 | Gary Dale Montgomery | Physician Assistant | 12800 Bothell Everett Hwy, Ste A, Everett, WA 98208-6642 | 2015-11-05 |
| 1457731556 | Laura Knapp | Counselor | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2015-06-03 |
| 1174903603 | Justin Gill | Nurse Practitioner | 12800 Bothell Everett Hwy, Everett, WA 98208 | 2015-05-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790270296 | Kenneth Britt Dyer | Registered Nurse | 10333 19th Ave, Se, Ste #109, Everett, WA 98208 | 2018-06-27 |
| 1518482215 | Glacier Peak Healthcare, Inc. | Home Health | 10530 19th Ave Se Ste 201, Everett, WA 98208 | 2017-08-03 |
| 1114454865 | Aliza Kreisman | Registered Nurse | 11020 19th Avenue Se, Kaiser Permanente of Washington Seattle Care Clinic, Everett, WA 98208 | 2017-05-12 |
| 1902269418 | Clay Eakin | Counselor | 2732 Grand Evenue, Everett, WA 98208 | 2016-04-01 |
| 1467810259 | Elizabeth Anne Powley | Marriage & Family Therapist | 1920 100th Street Southeast, Bld C3, Everett, WA 98208 | 2016-02-08 |
| 1659745842 | Andrea Rose Bedlington | Pharmacist | 11407 33rd Dr. Se, Everett, WA 98208 | 2015-11-25 |
| 1396123865 | Sound Surgeons Pllc | Clinic/Center | 125 130th Street Se, 1st Floor, Everett, WA 98208 | 2015-05-15 |
| 1831576537 | Chris Sturgeon | Counselor | 10102 Meridian Ave, Everett, WA 98208 | 2015-05-01 |
| 1982011128 | James M Lee | Physical Therapist | 10821 19th Ave Se Ste 102, Everett, WA 98208 | 2014-07-21 |
| 1972937357 | Ronald Tracy | Dentist | 10315 19th Avenue Se Suite 110, Everett, WA 98208 | 2013-08-21 |
| Find all providers in zip 98208 | ||||
| Taxonomy Code | 2471B0102X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| Specialization | Bone Densitometry |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821249939 | Providence Health & Services - Wa | Radiologic Technologist | 12800 Bothell Everett Hwy, Suite 160, Everett, WA 98208-6644 | 2008-10-07 |
| 1902057029 | Providence Health & Services - Wa | Radiologic Technologist | 1330 Rockefeller Ave, Suite 230, Everett, WA 98201-1676 | 2008-10-07 |
| 1093896854 | Providence Physician Group | Radiologic Technologist | 12800 Bothell Everett Hwy, Suite 160, Everett, WA 98208-6644 | 2006-10-18 |
| 1871515429 | Providence Physician Group | Radiologic Technologist | 1330 Rockefeller Ave, Suite 230, Everett, WA 98201-1684 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811942758 | Providence Health & Service - Washington | Radiologic Technologist | 908 S Scheuber Rd, Centralia, WA 98531-9027 | 2006-05-22 |
| 1396739207 | Robb Kelly | Radiologic Technologist | 19910 118th Ave Se, Renton, WA 98058-7570 | 2005-09-07 |
| 1558366708 | Donna R Quiles | Radiologic Technologist | 11019 Canyon Rd E, Puyallup, WA 98373-3001 | 2005-06-15 |
| 1225289333 | Providence Health & Services - Wa | Radiologic Technologist | 19200 N Kelsey St, Monroe, WA 98272-1431 | 2008-10-07 |
| 1518040484 | Providence Physician Group | Radiologic Technologist | 14692 179th Ave Se, Suite 100, Monroe, WA 98272-1198 | 2006-10-23 |
| 1083652085 | Meridian Bone Density Specialist | Radiologic Technologist | 11019 Canyon Rd E, Puyallup, WA 98373-3001 | 2006-06-02 |
Please comment or provide details below to improve the information on PROVIDENCE HEALTH & SERVICES - WASHINGTON.
| 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.