Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence Medical Group Southeast Washington
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
380 CHASE AVENUE, PMG SE WA, WALLA WALLA, WA 99362-2924
(509) 526-3333
(509) 526-8402
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(509) 529-8905
(509) 526-8402
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
Primary
H-050
WA
207R00000X
Internal Medicine Physician
H-050
WA
207X00000X
Orthopaedic Surgery Physician
H-050
WA
208600000X
Surgery Physician
H-050
WA
225000000X
Orthotic Fitter
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115284
L&I STATE
WA
05
—
7028186
—
WA
Enumeration date
10/10/2008
Last updated
02/17/2026
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