PROVIDENCE HEALTH & SERVICES - WASHINGTON (NPI# 1306097126) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306097126 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP SOUTHEAST WASHINGTON IMAGING |
| Practice Address |
401 W Poplar Street Pmg Se Wa Imaging Walla Walla WA 99362-2846 |
| Mailing Address |
Po Box 34439 Mailing / Credentialing Seattle WA 98124-1439 |
| Practice Telephone | 5095225850 |
| Practice Fax Number | 5095268402 |
| Mailing Telephone | 5095298905 |
| Mailing Fax Number | 5095268402 |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2012-09-25 |
| Authorized Official Name | MICHAEL PARENTEAU (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 5095225890 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | L&I FEDERAL | 191431900 | 01 |
| WA | 7138118 | 05 | |
| WA | L&I STATE | 222605 | 01 |
| Other Name | Type Code |
|---|---|
| Providence Medical Group Southeast Washington Imaging | 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 |
| 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 |
| 1376638171 | Providence Health & Services - Washington | Skilled Nursing Facility | 4900 Eagle St, Anchorage, AK 99503-7446 | 2006-10-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Health & Services - Washington | 1801 Lind Ave. Sw, #9016, Renton, WA 98057 |
| Street Address |
401 W POPLAR STREET PMG SE WA IMAGING |
| City | WALLA WALLA |
| State | WA |
| Zip Code | 99362-2846 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982856886 | Providence Health & Services - Washington | Radiology | 401 W Poplar Street, Pmg Se Wa Radiation Oncology, Walla Walla, WA 99362-2846 | 2008-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164065959 | Kevin Gia-minh Phan | Optometrist | Walla Walla Vamc Bldg 86, Walla Walla, WA 99362 | 2019-10-24 |
| 1659836401 | Arlene Lavonne Whitney | Social Worker | 1361 Dalles Military Road, Walla Walla, WA 99362 | 2019-02-06 |
| 1053880674 | Julie Ann Cooke | Speech-Language Pathologist | Providence St. Mary Medical Center, 401 W. Poplar St., Walla Walla, WA 99362 | 2018-11-14 |
| 1558887133 | Chantey Walker | Massage Therapist | 1840 Pleasant St, Walla Walla, WA 99362 | 2017-08-16 |
| 1447798723 | Carrie S Diede | Speech-Language Pathologist | 410 West Poplar Street, Rehabilitation Services, Walla Walla, WA 99362 | 2017-02-07 |
| 1235584103 | Anchor Point Counseling Pllc | Clinic/Center | 2330 Eastgate St. Ste. 140, Walla Walla, WA 99362 | 2016-04-28 |
| 1548627011 | Washington State Walla Walla Veterans Home | Skilled Nursing Facility | 92 Wainwright Drive, Walla Walla, WA 99362 | 2016-01-28 |
| 1073926200 | Sherry Goff | Registered Nurse | 11120 W Rose St, Family Medical Center, Walla Walla, WA 99362 | 2014-06-05 |
| 1538597935 | Michael Wade Gillespie | Orthopaedic Surgery | 101 Brookside Drive, Walla Walla, WA 99362 | 2013-10-22 |
| 1023357985 | Sandra Kay Bushnell | Speech-Language Pathologist | 1105 Isaacs Ave, Walla Walla, WA 99362 | 2013-02-12 |
| Find all providers in zip 99362 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336235332 | Korth Bingham | Radiology | 998 Reser Rd, Walla Walla, WA 99362-9070 | 2006-10-05 |
| 1457305179 | John Timothy Blackwelder | Radiology | 1240 Lancer Dr, Walla Walla, WA 99362-9275 | 2006-05-19 |
| 1093772808 | Allan F Avbel | Radiology | 306 Craig St, Walla Walla, WA 99362-3302 | 2006-04-26 |
| 1366435950 | Robert E Morris | Radiology | 3539 Mill Creek Rd, Walla Walla, WA 99362-8429 | 2005-08-30 |
| 1588944847 | Seth Brian Gillham | Radiology | 401 W Poplar St, Walla Walla, WA 99362-2846 | 2011-08-18 |
| 1194955443 | Grapevine Radiology Associates | Radiology | 1240 Lancer Dr, Walla Walla, WA 99362-9275 | 2009-07-21 |
| 1700064862 | David E Holznagel | Radiology | 401 W Poplar St, Walla Walla, WA 99362-2846 | 2008-01-31 |
| 1609063197 | Brian W Rich | Radiology | 1025 S 2nd Ave, Walla Walla, WA 99362-4116 | 2007-09-27 |
| 1699801720 | Patrick Edward Davis | Radiology | 401 W Poplar St, Walla Walla, WA 99362-2846 | 2007-02-25 |
| 1386746998 | Marc Brian Bruce | Radiology | 401 W Poplar St, Radiology, Walla Walla, WA 99362-2846 | 2006-09-03 |
| Find all providers in WALLA WALLA | ||||
| City | WALLA WALLA |
| Zip Code | 99362 |
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.