Organization
PROVIDENCE HEALTH & SERVICES-WASHINGTON
Active
Other names
PMG NW WA Monroe Pediatrics, PROVIDENCE PHYSICIAN 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
19200 N KELSEY ST, MONROE, WA 98272-1431
(360) 794-7994
(360) 805-4757
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(253) 589-7864
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/04/2008
Last updated
05/12/2025
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