Organization
PROVIDENCE HEALTH & SERVICES WASHINGTON
Active
Other names
PROVIDENCE FAMILY MEDICINE CHEWELAH
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
100 W SOUTH AVE, CHEWELAH, WA 99109-9684
(509) 935-8111
(509) 935-0970
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(509) 935-8111
(509) 935-0970
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/23/2022
Last updated
05/05/2025
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