Providence Medical Group Southeast Washington
LBN: Providence Health & Services - Washington
Providence Medical Group Southeast Washington is an health care organization with primary practice located at 380 Chase Avenue Pmg Se Wa, Walla Walla WA 99362-2924. The organization recently has 7 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Surgery, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotic Fitter, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Providence Health & Services - Washington can be contacted via phone (509) 526-3333, or through Anderson, Donald Wayne via phone (425) 525-5392.
Contact Information
Primary practice address
380 Chase Avenue Pmg Se Wa
Walla Walla WA 99362-2924
Phone: (509) 526-3333
Fax: (509) 526-8402
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | ||
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | H-050 | Washington |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | H-050 | Washington |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | H-050 | Washington |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | H-050 | Washington |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotic Fitter | 225000000X | ||
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X |
Profile Details
| NPI number | 1922259738 |
|---|---|
| LBN Legal business name | Providence Health & Services - Washington |
| DBA Doing business as | Providence Medical Group Southeast Washington |
| Authorized official | Anderson, Donald Wayne |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 10th, 2008 |
| Last updated | Sep 2nd, 2022 - about 2 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922259738 | NPPES |
| Washington | Other | 115284 | L&I STATE |
| Washington | MEDICAID | 7028186 | L&I STATE |
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