Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PMG SE WA - Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD WAYNE ANDERSON JR. (ASST SECRETARY-ENROLLMENT/ADMIN DIR)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1025 S 2ND AVE, WALLA WALLA, WA 99362-4116
(509) 897-5174
Mailing address
PO BOX 32, LIBERTY LAKE, WA 99019-0032
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
MTSC.FS.60877120
WA
Other
Enumeration date
07/11/2018
Last updated
05/06/2025
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