Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PMG NW WA N Everett Internal Medicine
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
1330 ROCKEFELLER AVE, SUITE 210, EVERETT, WA 98201-1676
(425) 261-4940
(425) 261-4945
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(425) 358-9786
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RI0200X
Infectious Disease Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/07/2008
Last updated
05/12/2025
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