# PROVIDENCE HEALTH & SERVICES- WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PMG NW WA Mill Creek Commons
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790014504
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 16708 BOTHELL-EVERETT HIGHWAY, SUITE 201, MILL CREEK, WA 98012-6345
- **Practice address phone:** (425) 482-9020
- **Practice address fax:** (425) 482-9021
- **Mailing address:** PO BOX 3360, PORTLAND, OR 97208-3360
- **Mailing address phone:** (866) 399-2983

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/08/2009
- **Last updated:** 05/09/2025