# 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:** 1922259738
- **Authorized official:** DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 380 CHASE AVENUE, PMG SE WA, WALLA WALLA, WA 99362-2924
- **Practice address phone:** (509) 526-3333
- **Practice address fax:** (509) 526-8402
- **Mailing address:** PO BOX 31001-4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (509) 529-8905
- **Mailing address fax:** (509) 526-8402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207Q00000X | Family Medicine Physician | H-050 | WA | Yes |
| 207R00000X | Internal Medicine Physician | H-050 | WA | — |
| 207X00000X | Orthopaedic Surgery Physician | H-050 | WA | — |
| 208600000X | Surgery Physician | H-050 | WA | — |
| 225000000X | Orthotic Fitter | — | NULL | — |
| 225000000X | Orthotic Fitter | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 10/10/2008
- **Last updated:** 02/17/2026