Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence Imaging Center
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
908 S SCHEUBER RD, CENTRALIA, WA 98531-9027
(360) 330-8880
Mailing address
909 N BROADWAY, PBO/CREDENTIALING, EVERETT, WA 98201-1409
(425) 317-0246
(425) 317-0291
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
602399531
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7124043
—
WA
Enumeration date
07/16/2007
Last updated
05/16/2025
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