# PROVIDENCE HEALTH & SERVICES WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Kodiak Island Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952430902
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1915 E REZANOF DR, KODIAK, AK 99615-6602
- **Practice address phone:** (907) 486-3281
- **Mailing address:** PO BOX 3706, PORTLAND, OR 97208-3706
- **Mailing address phone:** (907) 486-3281

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | Yes |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | Yes |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |
| 282NC0060X | Critical Access Hospital | 309115 | AK | — |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 05/13/2025