Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PMG NW WA Marysville Clinic
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
11603 STATE AVE, SUITE G, MARYSVILLE, WA 98271-8465
(360) 658-6800
(360) 658-6819
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(425) 358-9786
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/04/2008
Last updated
05/12/2025
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