# PROVIDENCE HEALTH & SERVICES WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Medical Group Southwest Washington
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134656135
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1018 CAPITOL WAY S STE 300, OLYMPIA, WA 98501-1212
- **Practice address phone:** (360) 486-6508
- **Practice address fax:** (360) 570-2077
- **Mailing address:** PO BOX 31001-4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (360) 486-6508

## 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:** 05/22/2017
- **Last updated:** 05/12/2025