Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PMG NW WA Ever Vascular Surg
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1330 ROCKEFELLER AVE, STE 520, EVERETT, WA 98201-1684
(425) 287-5200
(425) 287-5210
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(425) 358-9786
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
02/24/2011
Last updated
05/12/2025
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