Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY - ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
10200 MUKILTEO SPEEDWAY, MUKILTEO, WA 98275-4743
(425) 525-3194
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
12/16/2015
Last updated
07/31/2025
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