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Organization

PROVIDENCE HEALTH & SERVICES WASHINGTON

Active
Other names
Providence St Peter Hospital Diagnostic Imaging Lacey
Organization subpart
No

Provider details

NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization

Contact information

Practice address
4800 COLLEGE ST SE STE E, LACEY, WA 98503-4389
(360) 489-2960
(360) 489-2961
Mailing address
PO BOX 31001-4110, PASADENA, CA 91110-4110
(360) 489-2960

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary

Other

Enumeration date
10/17/2016
Last updated
05/13/2025
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