Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence St Mary DME
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
380 CHASE AVE, WALLA WALLA, WA 99362-2924
(509) 522-5900
(509) 522-5578
Mailing address
PO BOX 1477, WALLA WALLA, WA 99362-0312
(509) 522-5906
(509) 522-5789
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
H-050
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008478
L&I STATE
WA
05
—
9055955
—
WA
Enumeration date
10/10/2008
Last updated
05/06/2025
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