# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PMG NW WA MC Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821249939
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 12800 BOTHELL EVERETT HWY, SUITE 160, EVERETT, WA 98208-6644
- **Practice address phone:** (425) 316-5180
- **Practice address fax:** (425) 316-5181
- **Mailing address:** PO BOX 31001-4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (425) 358-9786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2471B0102X | Bone Densitometry Radiologic Technologist | — | NULL | — |
| 2471B0102X | Bone Densitometry Radiologic Technologist | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 10/07/2008
- **Last updated:** 05/14/2025