PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI# 1538413109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538413109 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES WASHINGTON |
| Other Organization Name | PROVIDENCE NORTHEAST WASHINGTON MEDICAL GROUP - KETTLE FALLS |
| Practice Address |
840 S Meyers St Kettle Falls WA 99141-7005 |
| Mailing Address |
Po Box 421 Liberty Lake WA 99019-0421 |
| Practice Telephone | 5096857848 |
| Mailing Telephone | 5096857848 |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2019-10-15 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASST SEC ENROLLMNT/DIR REIMB REG) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Providence NEWMG Kettle Falls | Doing Business As Name - Organization |
| PROVIDENCE NORTHEAST WASHINGTON MEDICAL GROUP - KETTLE FALLS | 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 |
840 S MEYERS ST |
| City | KETTLE FALLS |
| State | WA |
| Zip Code | 99141-7005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043208135 | Samuel A Artzis | Family Medicine | 840 S Meyers St, Kettle Falls, WA 99141 | 2005-10-12 |
| 1558748285 | Steven Tingey | Physician Assistant | 840 S Meyers St, Kettle Falls, WA 99141-7005 | 2015-05-01 |
| 1932285715 | Kerry A Michaelis | Physician Assistant | 840 S Meyers St, Kettle Falls, WA 99141-7005 | 2006-10-27 |
| 1326055831 | April S. Hume | Family Medicine | 840 S Meyers St, Kettle Falls, WA 99141-7005 | 2006-08-01 |
| 1780672725 | Edward D Johnson | Family Medicine | 840 S Meyers St, Kettle Falls, WA 99141 | 2005-10-13 |
| 1073501177 | Donald L Jackson | Physician Assistant | 840 S Meyers St, Kettle Falls, WA 99141 | 2005-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568739704 | Marnie Michelle Sly | Pharmacist | 1250 North Highway 395, Colville, WA 99141 | 2011-11-16 |
| 1902026248 | Fredrickson Chiropractic Clinic Ps | Chiropractor | 355 W 3rd St, Kettle Falls, WA 99141 | 2007-04-27 |
| 1336278233 | Shelley Sue Ericksen | Massage Therapist | 325b Third Ave, Kettle Falls, WA 99141 | 2007-03-05 |
| 1497807499 | Carrie Corbin | Specialist | 325 E 3 Rd Ave, Suite B, Kettle Falls, WA 99141 | 2007-01-18 |
| 1871668251 | Donna Bedgood Rosen | Counselor | 475 Meyer St, Kettle Falls, WA 99141 | 2006-11-21 |
| 1760552939 | Susan Lee Ridlington | Physical Therapist | 355 W 3rd, Kettle Falls, WA 99141 | 2006-11-08 |
| 1750460218 | Ron J Fredrickson | Chiropractor | 355 W. Third Avenue, Kettle Falls, WA 99141 | 2006-11-03 |
| 1962505099 | Kettle Falls School District | Local Education Agency (LEA) | East 225 8th Street, Kettle Falls, WA 99141 | 2006-09-06 |
| 1821128539 | Valley Drug Co | Pharmacy | 280 W 3rd Ave, Kettle Falls, WA 99141-0435 | 2007-03-06 |
| 1104451020 | Caitlyn Marie Aubertin | Massage Therapist | 25193 Highway 395 N, Kettle Falls, WA 99141-5006 | 2020-03-11 |
| Find all providers in zip 99141 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811555931 | Okanogan County Public Hospital Dist No 4 | Clinic/Center | 118 N Whitcomb Ave, Tonasket, WA 98855-8803 | 2019-06-04 |
| 1790204154 | Sunnyside Community Hospital Association | Clinic/Center | 715 N Park Ctr, Selah, WA 98942-1174 | 2017-09-15 |
| 1699215384 | Sunnyside Community Hospital Association | Clinic/Center | 505 W 4th Ave, Toppenish, WA 98948-1615 | 2017-03-01 |
| 1609112739 | Grant County Public Hospital District. No. 1 | Clinic/Center | 8420 Aspi Blvd, Moses Lake, WA 98837-1820 | 2012-12-18 |
| 1801188073 | Jefferson County Public Hospital District No 2 | Clinic/Center | 89 Breaker Ln, Port Ludlow, WA 98365-9766 | 2011-05-06 |
| 1255651907 | Family Care Network Pllc | Clinic/Center | 2511 M Ave Ste A, Anacortes, WA 98221-3897 | 2010-06-04 |
| 1871822676 | Public Hospital District 3 of Pacific County | Clinic/Center | 167 1st Avenue North, Ilwaco, WA 98624-0319 | 2009-12-08 |
| 1720276207 | Richard L. Dickson | Clinic/Center | 481 West E St, Forks, WA 98331 | 2007-10-09 |
| 1316138720 | L. Keith Hanson Pllc | Clinic/Center | 520 W. Indian Avenue, Brewster, WA 98812 | 2007-08-09 |
| 1407055742 | San Juan Healthcare PC | Clinic/Center | 689 Airport Center Dr Suite B, Friday Harbor, WA 98250 | 2007-07-17 |
| Find all providers with the same taxonomy | ||||
| City | KETTLE FALLS |
| Zip Code | 99141 |
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.