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Organization
PROVIDENCE HEALTH & SERVICES WASHINGTON
Active
Organization
PROVIDENCE HEALTH & SERVICES WASHINGTON
Active
Other names
Providence Health & Services Washington (PMG SE WA) - Express Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1705 SE MEADOWBROOK BLVD, SUITE 2, COLLEGE PLACE, WA 99324-1756
(509) 987-2450
Mailing address
PO BOX 32, LIBERTY LAKE, WA 99019-0032
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
08/22/2016
Last updated
05/06/2025
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