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Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence St Mary Med Ctr ER
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
401 W POPLAR ST, WALLA WALLA, WA 99362-2846
(509) 522-5802
(509) 522-5541
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(509) 522-5906
(509) 522-5789
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
H-050
WA
207R00000X
Internal Medicine Physician
—
—
282N00000X
General Acute Care Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025341
L&I STATE
WA
05
—
7159205
—
WA
Enumeration date
10/10/2008
Last updated
05/07/2025
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