Organization
PROVIDENCE HEALTH & SERVICES WASHINGTON
Active
Other names
PMG SW WA, Centralia Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1010 S SCHEUBER RD, CENTRALIA, WA 98531-8892
(360) 827-7966
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(360) 827-7966
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/18/2022
Last updated
05/12/2025
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