Organization
PROVIDENCE HEALTH & SERVICES WASHINGTON
Active
Other names
Providence Medical Group SW WA - MDPP
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
4800 COLLEGE ST SE, LACEY, WA 98503-4389
(360) 493-7567
(360) 412-6468
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(360) 493-7567
(360) 412-6468
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/21/2018
Last updated
05/12/2025
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