PROVIDENCE PHYSICIAN GROUP (NPI# 1518040484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518040484 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
14692 179th Ave Se Suite 100 Monroe WA 98272-1198 |
| Mailing Address |
909 N Broadway Everett WA 98201-1409 |
| Practice Telephone | 3607947994 |
| Practice Fax Number | 3608054755 |
| Mailing Telephone | 4253170257 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-11-21 |
| Authorized Official Name | EARL D. BEEGLE (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 4253165470 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2471B0102X |
Radiologic Technologist Specialization: Bone Densitometry |
Technologists, Technicians & Other Technical Service Providers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7096183 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932270360 | Providence Physician Group | Dermatology | 12800 Bothell Everett Hwy, Suite 260, Everett, WA 98208-6642 | 2006-11-09 |
| 1639258130 | Providence Physician Group | Clinic/Center | 12800 Bothell Everett Hwy, Suite 120, Everett, WA 98208-6642 | 2006-11-03 |
| 1073699922 | Providence Physician Group | Neurological Surgery | 2320 Rucker Ave, Suite A, Everett, WA 98201-2723 | 2006-10-31 |
| 1972686848 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 800, Monroe, WA 98272-1198 | 2006-10-23 |
| 1699858563 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 1330 Rockefeller Ave, Suite 220, Everett, WA 98201-1684 | 2006-10-23 |
| 1619050580 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 12800 Bothell Everett Hwy, Suite 180, Everett, WA 98208-6642 | 2006-10-23 |
| 1528141496 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 12800 Bothell Everett Hwy, Suite 190, Everett, WA 98208-6642 | 2006-10-23 |
| 1093896854 | Providence Physician Group | Radiologic Technologist | 12800 Bothell Everett Hwy, Suite 160, Everett, WA 98208-6644 | 2006-10-18 |
| 1225119050 | Providence Physician Group | Internal Medicine | 5007 Claremont Way, Everett, WA 98203-3321 | 2006-10-18 |
| 1548282189 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 900, Monroe, WA 98272-1198 | 2006-07-24 |
| Street Address |
14692 179TH AVE SE SUITE 100 |
| City | MONROE |
| State | WA |
| Zip Code | 98272-1198 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952342974 | Paul W Boone Jr. | Family Medicine | 14692 179th Ave Se, Suite 500, Monroe, WA 98272-1198 | 2006-06-09 |
| 1215225099 | Providence Health & Services-wa | Midwife | 14692 179th Ave Se, Ste 800, Monroe, WA 98272-1162 | 2011-07-14 |
| 1447547658 | Providence Health & Services-wa | Registered Nurse | 14692 179th Ave Se, Ste 800, Monroe, WA 98272-1162 | 2011-07-08 |
| 1720391758 | Carmela Batallones Andrada | Pharmacist | 14692 179th Ave Se, Monroe, WA 98272-1198 | 2010-07-20 |
| 1902139959 | Priscilla Grace Navaja | Pharmacist | 14692 179th Ave Se, Suite 200, Monroe, WA 98272-1198 | 2009-09-09 |
| 1427282250 | Melissa Dawn Goldsmith | Specialist | 14692 179th Ave Se, Suite 400, Monroe, WA 98272-1198 | 2009-05-07 |
| 1457502551 | Providence Health & Services-wa | Clinic/Center | 14692 179th Ave Se, Suite 100, Monroe, WA 98272-1198 | 2008-10-07 |
| 1538345194 | Foot Care Associates PC | Podiatrist | 14692 179th Ave Se, Monroe, WA 98272 | 2008-01-14 |
| 1366625030 | Harmony Lynn Mckenna-clark | Specialist | 14692 179th Ave Se, Suite 400, Monroe, WA 98272-1198 | 2007-12-17 |
| 1558544098 | Nancy Lynnette Rukman | Specialist | 14692 179th Ave Se, Suite 400, Monroe, WA 98272-1198 | 2007-12-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710346135 | Kiran Agarwal | Internal Medicine | 17707 W Main St Fl 1, Monroe, WA 98272 | 2016-02-12 |
| 1982073136 | Rochelle Conway Toulouse | Behavioral Analyst | 642 North Street, Monroe, WA 98272 | 2015-09-17 |
| 1740658467 | Casey Jane Bahr | Social Worker | Casey Bahr, C.o. Tru- Sotap, 16550 177th Ave Se, Monroe, WA 98272 | 2015-09-11 |
| 1811395049 | Gianna M Rosewood | Massage Therapist | 101 East Main Street Set 201, Monroe, WA 98272 | 2014-12-22 |
| 1528478609 | Puget Sound Kidney Centers | Clinic/Center | 18121 149th Street Se, Monroe, WA 98272 | 2014-04-29 |
| 1215356878 | Sabiha K Barot | Emergency Medicine | Evergreenhealth Monroe, 14701 179th Ave. Se, Monroe, WA 98272 | 2014-04-10 |
| 1346677986 | Irina Emily Goldstein | Pharmacist | 179th Ave Se, Monroe, WA 98272 | 2013-09-27 |
| 1740612449 | Erik Michael Erxleben | Massage Therapist | 211 West Hill St., Monroe, WA 98272 | 2013-08-05 |
| 1780023796 | Jamie Marlo Selbe | Counselor | 16560 167th St Se, Monroe, WA 98272 | 2013-06-24 |
| 1942644620 | Robin Fenn | Counselor | 14841 179th Ave Se, St 230, Neary Naturopathic Clinic, Monroe, WA 98272 | 2013-04-24 |
| Find all providers in zip 98272 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972124832 | Jessica Womack | Family Medicine | 527 W Hurd Rd, Monroe, MI 48162-9205 | 2020-05-01 |
| 1134781412 | Joshua Dwaine Lentz | Family Medicine | Promedica Monroe Regional Hospital, 650 Stewart Road, Monroe, MI 48162 | 2019-07-08 |
| 1376000620 | Paladina Health, LLC | Family Medicine | Paladina Health Monroe Campus Park, 1640 A Campus Park Drive, Monroe, NC 28112 | 2019-02-22 |
| 1457822991 | Affinity Health Group, LLC | Family Medicine | 920 Oliver Rd Ste A2, Monroe, LA 71201-5702 | 2018-12-10 |
| 1144601121 | Rebecca Redding | Family Medicine | 924 W Spring St Ste A, Monroe, GA 30655-1751 | 2015-06-15 |
| 1285069088 | Geaux Family Health, LLC | Family Medicine | 2408 Duval Dr, Suite 1, Monroe, LA 71201-2986 | 2013-09-11 |
| 1033559844 | Mvhe, Inc | Family Medicine | 20 Overbrook Dr Ste C, Monroe, OH 45050-1147 | 2013-06-26 |
| 1982048237 | Erin Robinson Breard | Family Medicine | 3995 Sterlington Rd, Ste A, Monroe, LA 71203-3723 | 2013-04-17 |
| 1659614022 | Mercy Memorial Hospital Corporation | Family Medicine | 650 Steward Road, Monroe, MI 48162 | 2013-04-03 |
| 1598015968 | Urban Medical Clinic, Inc. | Family Medicine | 1910 Jackson St., Monroe, LA 71202-2532 | 2012-09-13 |
| Find all providers in MONROE | ||||
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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.