# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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

## Provider details

- **NPI number:** 1326569682
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 380 CHASE AVE, WALLA WALLA, WA 99362-2924
- **Practice address phone:** (509) 526-3333
- **Mailing address:** PO BOX 31001 - 4110, PASADENA, CA 91110-4110

## 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 | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 06/27/2017
- **Last updated:** 03/03/2026