# PROVIDENCE HEALTH & SERVICES - WA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PMG NW WA H P Urgent Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003050709
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 4112 HARBOUR POINTE BLVD SW, SUITE100, MUKILTEO, WA 98275-5457
- **Practice address phone:** (425) 347-6350
- **Practice address fax:** (425) 347-6335
- **Mailing address:** PO BOX 34439, SEATTLE, WA 98124-1439
- **Mailing address phone:** (425) 316-5469
- **Mailing address fax:** (425) 316-5484

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 04/24/2009
- **Last updated:** 07/25/2025