Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up