# PROVIDENCE HEALTH & SERVICES- WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PMG NW WA, PROVIDENCE MEDICAL GROUP NORTHWEST WASHINGTON
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124270715
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 900 PACIFIC AVE, STE 501, EVERETT, WA 98201-4168
- **Practice address phone:** (425) 258-7550
- **Practice address fax:** (425) 258-7450
- **Mailing address:** PO BOX 31001-4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (425) 358-9786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 10/15/2008
- **Last updated:** 02/19/2026