PROVIDENCE PHYSICIAN GROUP (NPI# 1699701987) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699701987 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
14692 179th Ave Se Suite 500 Monroe WA 98272-1198 |
| Mailing Address |
909 N Broadway Pbo/credentialing Everett WA 98201-1409 |
| Practice Telephone | 3607947994 |
| Practice Fax Number | 3608054757 |
| Mailing Telephone | 4253170246 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2010-03-11 |
| Authorized Official Name | MS. BARBARA SCHUMACHER (PRO FEE CREDENTIALING MANAGER) |
| Authorized Official Telephone | 3607947994 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| 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 |
| 1518040484 | Providence Physician Group | Radiologic Technologist | 14692 179th Ave Se, Suite 100, Monroe, WA 98272-1198 | 2006-10-23 |
| 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 |
| Street Address |
14692 179TH AVE SE SUITE 500 |
| 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 | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| 1730667320 | Ideal Option, Pllc | Clinic/Center | 14523 169th Drive, Suite 773, Monroe, WA 98272-2935 | 2018-08-06 |
| 1669918892 | Strong Health and Wellness | Clinic/Center | 1335 W Roosevelt Blvd, Monroe, NC 28110-2821 | 2017-01-11 |
| 1861702680 | Healthpoint Center, LLC | Clinic/Center | 400 Stubbs Ave, Monroe, LA 71201-5506 | 2010-10-14 |
| 1689988149 | Exodus Clinic LLC | Clinic/Center | 671 State Route 17m, Monroe, NY 10950-3318 | 2010-07-27 |
| 1558692871 | Exodus Clinic, LLC | Clinic/Center | 7 Rieger Dr, Monroe, NY 10950-1628 | 2010-01-26 |
| 1598918633 | Cynthia Brown Manning Md, Apmc | Clinic/Center | 1825 North 18th St, Suite B, Monroe, LA 71201 | 2008-11-03 |
| 1588828560 | Head To Toe Research & Wellness, LLC | Clinic/Center | 307 S Broad St, Monroe, GA 30655-2119 | 2008-07-18 |
| 1447436829 | The Monroe Medical Foundation for Research and Education, Inc | Clinic/Center | 411 22nd Ave, Monroe, WI 53566-1576 | 2008-01-15 |
| 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.