PROVIDENCE PHYSICIAN GROUP (NPI# 1073699922) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073699922 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
2320 Rucker Ave Suite A Everett WA 98201-2723 |
| Mailing Address |
909 N Broadway Pbo/credentialing Everett WA 98201-1409 |
| Practice Telephone | 4252595121 |
| Practice Fax Number | 4252521322 |
| Mailing Telephone | 4253170246 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2010-03-11 |
| Authorized Official Name | MS. BARBARA SCHUMACHER (PRO FEE CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4252595121 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932270360 | Providence Physician Group | Dermatology | 12800 Bothell Everett Hwy, Suite 260, Everett, WA 98208-6642 | 2006-11-09 |
| 1639258130 | Providence Physician Group | Clinic/Center | 12800 Bothell Everett Hwy, Suite 120, Everett, WA 98208-6642 | 2006-11-03 |
| 1518040484 | Providence Physician Group | Radiologic Technologist | 14692 179th Ave Se, Suite 100, Monroe, WA 98272-1198 | 2006-10-23 |
| 1972686848 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 800, Monroe, WA 98272-1198 | 2006-10-23 |
| 1699858563 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 1330 Rockefeller Ave, Suite 220, Everett, WA 98201-1684 | 2006-10-23 |
| 1619050580 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 12800 Bothell Everett Hwy, Suite 180, Everett, WA 98208-6642 | 2006-10-23 |
| 1528141496 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 12800 Bothell Everett Hwy, Suite 190, Everett, WA 98208-6642 | 2006-10-23 |
| 1093896854 | Providence Physician Group | Radiologic Technologist | 12800 Bothell Everett Hwy, Suite 160, Everett, WA 98208-6644 | 2006-10-18 |
| 1225119050 | Providence Physician Group | Internal Medicine | 5007 Claremont Way, Everett, WA 98203-3321 | 2006-10-18 |
| 1548282189 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 900, Monroe, WA 98272-1198 | 2006-07-24 |
| Street Address |
2320 RUCKER AVE SUITE A |
| City | EVERETT |
| State | WA |
| Zip Code | 98201-2723 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003881020 | James Potocsnak | Physician Assistant | 2320 Rucker Ave, Everett, WA 98201 | 2006-02-22 |
| 1083264352 | Maio Counseling LLC | Counselor | 2320 Rucker Ave, Suite 203, Everett, WA 98201 | 2019-09-18 |
| 1144471533 | Providence Health & Services - Wa | Neurological Surgery | 2320 Rucker Ave, Suite A, Everett, WA 98201-2723 | 2008-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306471867 | Shannon Michelle Dewald | Registered Nurse | D8s 1700 13th St, Everett, WA 98201 | 2020-03-05 |
| 1578123113 | Precious Medicial Spa, LLC | Registered Nurse | 1728 W. Marine View Dr Suite 212, Everett, WA 98201 | 2019-06-17 |
| 1508429796 | Alix Deschain | Counselor | 2801 Broadway, Everett, WA 98201 | 2019-04-15 |
| 1811457534 | Khushboo Patel | Pharmacist | 1330 Rockefeller Ave Ste 150, Everett, WA 98201 | 2019-03-20 |
| 1164991188 | Grace Talbot Davis | Registered Nurse | 2601 Summit Avenue, Bldg. C, Everett, WA 98201 | 2018-11-20 |
| 1063924603 | Tracy Sisk | Counselor | 3120 Colby Ave, 502, Everett, WA 98201 | 2017-11-03 |
| 1710403126 | Michelle Durham | Counselor | 3322 Boadway Fl 2, Everett, WA 98201 | 2017-08-17 |
| 1861927949 | Melanie Schmidt | Counselor | 2610 Westmore Ave, Everett, WA 98201 | 2017-04-26 |
| 1518413327 | Joseph Madson Dmd Pllc | Clinic/Center | 3802 Colby Ave, 4th Floor, Everett, WA 98201 | 2016-08-31 |
| 1043683162 | Jennifer Adams | Counselor | 1511 26th St, Everett, WA 98201 | 2015-11-11 |
| Find all providers in zip 98201 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578606554 | James J Wang | Neurological Surgery | 1321 Colby Avle, Medical Staff Office, Everett, WA 98201-1665 | 2007-02-15 |
| 1780657601 | Martin Carlos Holland | Neurological Surgery | 1717 13th St Ste 401, Everett, WA 98201 | 2006-02-10 |
| 1346546322 | Forrest Duen-huei Hsu | Neurological Surgery | 1717 13th St Ste 401, Everett, WA 98201 | 2011-02-08 |
| 1912230988 | Ruth Thiex | Neurological Surgery | 1717 13th St, Ste 401, Everett, WA 98201-1621 | 2009-09-09 |
| 1144471533 | Providence Health & Services - Wa | Neurological Surgery | 2320 Rucker Ave, Suite A, Everett, WA 98201-2723 | 2008-10-04 |
| 1295909901 | Daniel Alexander Clayton | Neurological Surgery | 1717 13th St, Suite 401, Everett, WA 98201-1621 | 2008-04-15 |
| 1083715072 | James Michael Geier | Neurological Surgery | 1330 Rockefeller Ave, Suite 220, Everett, WA 98201-1684 | 2006-09-25 |
| 1720053564 | Sanford J Wright Jr. | Neurological Surgery | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306311386 | David W. Newell M.d. P.s. | Neurological Surgery | 1370 116th Ave Ne Ste 105, Bellevue, WA 98004-3825 | 2018-10-05 |
| 1891243820 | Kiana Uylukcu | Neurological Surgery | Medex Northwest, 4311 11th Avenue Ne, Suite 200, Seattle, WA 98105-3007 | 2016-09-19 |
| 1346691953 | James M Blue | Neurological Surgery | 4882 Forest Ave S.e., Mercer Island, WA 98040 | 2016-06-24 |
| 1427406883 | Fourth Corner Neurosurgical Associates | Neurological Surgery | 710 Birchwood Ave Ste 101, Bellingham, WA 98225-1720 | 2016-05-26 |
| 1659618510 | Antonio A Moure | Neurological Surgery | 1521 2nd Ave, Apartment 1400, Seattle, WA 98101-4500 | 2013-01-12 |
| 1699033894 | Calvin Curtis Whaley | Neurological Surgery | 550 17th Ave Ste 110, Seattle, WA 98122-5789 | 2012-04-25 |
| 1760752240 | David Elbert Grayson | Neurological Surgery | 17625 Se 45th Pl, Bellevue, WA 98006-6520 | 2011-12-30 |
| 1366734063 | Northwest Spine, Pllc | Neurological Surgery | 1017 S 40th Ave, Yakima, WA 98908-3805 | 2011-05-12 |
| 1396050845 | Vincent Edward Bryan Jr. | Neurological Surgery | 342 Silica Rd Nw, Quincy, WA 98848-9468 | 2010-08-09 |
| 1760636690 | Providence Health & Services - Washington | Neurological Surgery | 301 W Poplar Street, Ste 220, Walla Walla, WA 99362-2800 | 2008-11-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.