Organization
PROVIDENCE HEALTH & SERVICES-WA
Active
Other names
NW Heart & Lung Surgical Assoc
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
62 W 7TH AVE STE 110, SPOKANE, WA 99204-2321
(509) 456-0262
(509) 462-5059
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(509) 456-0262
(425) 276-3215
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
600503828
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8878011
MEDICARE PTAN
WA
01
—
G8878024
MEDICARE PTAN
WA
Enumeration date
10/14/2008
Last updated
05/08/2025
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