# PROVIDENCE HEALTH & SERVICES WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Health & Services Washington (PMG SE WA) - Express Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023563897
- **Authorized official:** MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1705 SE MEADOWBROOK BLVD, SUITE 2, COLLEGE PLACE, WA 99324-1756
- **Practice address phone:** (509) 987-2450
- **Mailing address:** PO BOX 32, LIBERTY LAKE, WA 99019-0032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/22/2016
- **Last updated:** 05/06/2025