PROVIDENCE HEALTH & SERVICES - WASHINGTON (NPI# 1922259738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922259738 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP SOUTHEAST WASHINGTON |
| Practice Address |
380 Chase Avenue Pmg Se Wa Walla Walla WA 99362-2924 |
| Mailing Address |
Po Box 32 Liberty Lake WA 99019-0032 |
| Practice Telephone | 5095263333 |
| Practice Fax Number | 5095268402 |
| Mailing Telephone | 5095298905 |
| Mailing Fax Number | 5095268402 |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2019-04-29 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASST SEC OF ENROLLMENT/DIR REIMB ST) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | H-050 | WA | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | H-050 | WA | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | H-050 | WA | Allopathic & Osteopathic Physicians |
| N | 225000000X | Orthotic Fitter | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 207Q00000X | Family Medicine | H-050 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7028186 | 05 | |
| WA | L&I STATE | 115284 | 01 |
| Other Name | Type Code |
|---|---|
| Providence Medical Group Southeast Washington | 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 |
| 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 |
| 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 |
380 CHASE AVENUE PMG SE WA |
| City | WALLA WALLA |
| State | WA |
| Zip Code | 99362-2924 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891046926 | Providence Health & Services - Washington | Clinic/Center | 380 Chase Avenue, Pmg Se Wa Rural Health Clinic, Walla Walla, WA 99362-2924 | 2012-09-28 |
| 1154672947 | Providence Health & Services - Washington | Internal Medicine | 380 Chase Avenue, Pmg Se Wa Rural Health Clinic, Walla Walla, WA 99362-2924 | 2012-09-20 |
| 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 | 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 |
|---|---|---|---|---|
| 1609965144 | Peter Viavant | Family Medicine | 218 E Langdon Rd, Walla Walla, WA 99362-8593 | 2006-10-12 |
| 1730287814 | James Uzoma Opara | Family Medicine | 1120 West Rose Street, Walla Walla, WA 99362 | 2006-09-20 |
| 1700809167 | George Robert Waring | Family Medicine | 380 Chase St, Walla Walla, WA 99362 | 2006-07-26 |
| 1568449288 | John Anton Fackenthall | Family Medicine | 1312 E Isaacs Ave, Walla Walla, WA 99362-2152 | 2005-12-22 |
| 1669478137 | Robert G. Morasch | Family Medicine | 380 Chase Street, Family Practice, Walla Walla, WA 99362-0312 | 2005-06-21 |
| 1760921423 | Trinity Medical PC | Family Medicine | 1025 S 2nd Ave, Walla Walla, WA 99362-4116 | 2017-02-14 |
| 1790045045 | Jeff M Pryor | Family Medicine | 55 W Tietan St, Walla Walla, WA 99362-4445 | 2012-05-21 |
| 1558599654 | John R. Stoddard | Family Medicine | 380 Chase Ave, Providence Medical Group, Walla Walla, WA 99362 | 2009-06-26 |
| 1457506941 | Planned Parenthood of Greater Washington & North Idaho | Family Medicine | 828 South 1st Avenue, Walla Walla, WA 99362 | 2008-11-25 |
| 1659552057 | John Anton Fackenthall | Family Medicine | 1312 E Isaacs Ave, Walla Walla, WA 99362-2152 | 2007-11-14 |
| 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.