# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH & SERVICES WASHINGTON
- **Other names:** Providence Medical Group Southeast Washington Rural Health Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1154672947
- **Legal business name:** PROVIDENCE HEALTH & SERVICES WASHINGTON
- **Authorized official:** DONALD WAYNE ANDERSON (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 380 CHASE AVENUE, PMG SE WA RURAL HEALTH CLINIC, WALLA WALLA, WA 99362-2924
- **Practice address phone:** (509) 526-3333
- **Practice address fax:** (509) 526-8402
- **Mailing address:** PO BOX 34439, PMG SE WA RURAL HEALTH CLINIC, SEATTLE, WA 98124-1439
- **Mailing address phone:** (509) 526-3333
- **Mailing address fax:** (509) 526-8402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/20/2012
- **Last updated:** 05/06/2025