Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PMG NW WA MC Pediatrics
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 190, EVERETT, WA 98208-6644
(425) 316-5160
(425) 225-1005
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(425) 358-9786
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/04/2008
Last updated
05/12/2025
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