# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Physician Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306201488
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY - ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 10200 MUKILTEO SPEEDWAY, MUKILTEO, WA 98275-4743
- **Practice address phone:** (425) 525-3194
- **Mailing address:** PO BOX 3360, PORTLAND, OR 97208-3360

## 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:** 12/16/2015
- **Last updated:** 07/31/2025