# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH AND SERVICES ALASKA
- **Other names:** Providence Matanuska Health Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1093720534
- **Legal business name:** PROVIDENCE HEALTH AND SERVICES ALASKA
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 2250 S. WOODWORTH LOOP, SUITE 101, PALMER, AK 99645
- **Practice address phone:** (907) 761-5900
- **Practice address fax:** (907) 761-5975
- **Mailing address:** PO BOX 4105, PORTLAND, OR 97208-4105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 05/15/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | MDG669 | — | AK |