Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence Physician Group Dexascan PHCC
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
12800 BOTHELL EVERETT HWY, SUITE 260B, EVERETT, WA 98208-6642
(425) 316-5425
(425) 316-5427
Mailing address
909 N BROADWAY, PBO/CREDENTIALING, EVERETT, WA 98201-1409
(425) 317-0246
(425) 317-0291
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2471B0102X
Bone Densitometry Radiologic Technologist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093896854
OLD NPI
—
Enumeration date
10/16/2008
Last updated
07/31/2025
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