Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Other names
Providence Medical Group Southeast Washington Imaging
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Authorized official
DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
401 W POPLAR STREET, PMG SE WA IMAGING, WALLA WALLA, WA 99362-2846
(509) 522-5850
(509) 526-8402
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(509) 529-8905
(509) 526-8402
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191431900
L&I FEDERAL
WA
01
—
222605
L&I STATE
WA
05
—
7138118
—
WA
Enumeration date
10/10/2008
Last updated
05/06/2025
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