PROVIDENCE HEALTH & SERVICES - WASHINGTON (NPI# 1417191057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417191057 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Other Organization Name | PROVIDENCE SMMC UROLOGY DME |
| Practice Address |
301 W Poplar St Suite 50 Walla Walla WA 99362-2858 |
| Mailing Address |
209 W Poplar St Po Box 1477 Walla Walla WA 99362-2828 |
| Practice Telephone | 5095225832 |
| Practice Fax Number | 5095225516 |
| Mailing Telephone | 5095225906 |
| Mailing Fax Number | 5095225789 |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2009-04-27 |
| Authorized Official Name | SUSAN A COLUMBER (RCM DIRECTOR) |
| Authorized Official Telephone | 5095225906 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | HAC.FS.00000050 | WA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Providence SMMC Urology DME | Other Name - Individual/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 |
301 W POPLAR ST SUITE 50 |
| City | WALLA WALLA |
| State | WA |
| Zip Code | 99362-2858 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164427456 | Guy Frank Gehling | Neurological Surgery | 301 W Poplar St, Ste 220, Walla Walla, WA 99362-2858 | 2005-06-14 |
| 1497254635 | Corey Carson | Physician Assistant | 301 W Poplar St, Walla Walla, WA 99362-2858 | 2018-02-02 |
| 1174814552 | Providence Health & Services - Washington | Durable Medical Equipment & Medical Supplies | 301 W Poplar St, Walla Walla, WA 99362-2858 | 2011-04-20 |
| 1699000901 | Chelane R Fackenthall | Registered Nurse | 301 W Poplar St, Suite 100, Walla Walla, WA 99362-2858 | 2009-10-05 |
| 1326282963 | Providence Health & Services - Washington | Otolaryngology | 301 W Poplar St, Suite 210, Walla Walla, WA 99362-2858 | 2009-04-27 |
| 1235373879 | Providence Health & Services - Washington | Internal Medicine | 301 W Poplar St, Suite 100, Walla Walla, WA 99362-2858 | 2009-04-27 |
| 1811130156 | Providence Health & Services - Washington | Surgery | 301 W Poplar St, Suites 50, Walla Walla, WA 99362-2858 | 2009-04-16 |
| 1104070598 | Brianne Nicole Bridgeland | Registered Nurse | 301 W Poplar St, Suite #210, Walla Walla, WA 99362-2858 | 2008-11-11 |
| 1417165382 | Jennifer W Leach | Internal Medicine | 301 W Poplar St, Suite 100, Walla Walla, WA 99362-2858 | 2007-05-21 |
| 1194949594 | Jason Adam Dreyer | Neurological Surgery | 301 W Poplar St, Walla Walla, WA 99362-2858 | 2007-04-13 |
| Find all providers in the same location | ||||
| 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 | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932113347 | David A Hutton | Urology | 380 Chase Ave, Walla Walla, WA 99362-2924 | 2006-07-28 |
| 1245204007 | John G Sislow | Urology | 55 W Tietan St, Walla Walla, WA 99362-4445 | 2006-02-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295371532 | Jeffrey Allen Zhan | Urology | Good Samaritan Medical Office Bldg 1450 5th St Se, Suite 2100- Urology Clinic, Puyallup, WA 98372 | 2019-11-21 |
| 1023400041 | Pacific Northwest Urology Specialists, Pllc | Urology | 4545 Cordata Pkwy Ste 1a, Bellingham, WA 98226-7264 | 2015-02-27 |
| 1598182818 | Boston Medical Group- Washington, P.C. | Urology | 12301 N.e. 10th Place, Suite 101, Bellevue, WA 98005 | 2014-03-25 |
| 1033552823 | Carol Collins | Urology | 272 Health Sciences, 1959 Ne Pacific St, Seattle, WA 98195-7610 | 2013-04-10 |
| 1740523158 | Kacey Helena Provenzano | Urology | 780 Swift Blvd Ste 201, Richland, WA 99352 | 2013-04-03 |
| 1023366283 | William P Griggs | Urology | 2160 Dellesta Dr, Bellingham, WA 98226-7850 | 2012-08-20 |
| 1710242714 | Ralph Vernon Stagner | Urology | 3414 Horsehead Bay Dr. N.w., Gig Harbor, WA 98335 | 2012-07-06 |
| 1043579980 | Richard Kenneth Ohme | Urology | 3108 E Bay Dr Nw, Gig Harbor, WA 98335-7610 | 2012-05-13 |
| 1730447731 | Daniel Christian Sackman | Urology | 3124 South 19th St #c320, Tacoma, WA 98405-3011 | 2012-04-26 |
| 1144595299 | Philip Clark May | Urology | 11911 Ne 132nd St Ste 200, Kirkland, WA 98034 | 2012-03-21 |
| Find all providers with the same taxonomy | ||||
| City | WALLA WALLA |
| Zip Code | 99362 |
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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.