Organization
PROVIDENCE HEALTH & SERVICES WASHINGTON
Active
Other names
PROVIDENCE MEDICAL GROUP
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
101 W 8TH AVE, MOTHER GAMELIN CENTER 3RD FLOOR, SPOKANE, WA 99204-2307
(509) 474-2072
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1223G0001X
General Practice Dentistry
—
—
207Q00000X
Family Medicine Physician
—
—
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Enumeration date
03/06/2012
Last updated
05/11/2026
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