PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI# 1366641755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1366641755 |
Entity Type | Organization |
Organization Name | PROVIDENCE HEALTH & SERVICES WASHINGTON |
Other Organization Name | PROVIDENCE ST PETER HOSPITAL - 2ND CLAIMS |
Practice Address |
4800 College St Se Lacey WA 98503-4389 |
Mailing Address |
Po Box 34439 Seattle WA 98124-1439 |
Practice Telephone | 3604567575 |
Practice Fax Number | 3604935088 |
Mailing Telephone | 4255256778 |
Mailing Fax Number | 4255256700 |
Enumeration Date | 2007-07-16 |
Last Update Date | 2010-12-22 |
Authorized Official Name | NICOLE QUINN (PAYOR CREDENTIAILING MANAGER) |
Authorized Official Telephone | 4255256715 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
34 0153 00 | WA | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WA | UNIFIED BUSINESS ID | 342 006 812 | 01 |
WA | DEPARTMENT OF HEALTH - AL | AH-006 | 01 |
Other Name | Type Code |
---|---|
Providence St Peter Hospital - 2nd Claims | Other Name - Individual/Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1134656135 | Providence Health & Services Washington | Clinic/Center | 1018 Capitol Way S Ste 300, Olympia, WA 98501-1212 | 2017-05-22 |
1023550050 | Providence Health & Services Washington | Psychologist | 225 State Ave Ne, Olympia, WA 98501-6951 | 2016-11-08 |
1003367863 | Providence Health & Services Washington | Radiology | 4800 College St Se Ste E, Lacey, WA 98503-4389 | 2016-10-17 |
1023563897 | Providence Health & Services Washington | Clinic/Center | 1705 Se Meadowbrook Blvd, Suite 2, College Place, WA 99324-1756 | 2016-08-22 |
1457721250 | Providence Health & Services Washington | Clinic/Center | 1200 Basich Blvd, Aberdeen, WA 98520-1035 | 2015-10-06 |
1902141500 | Providence Health & Services Washington | Clinical Medical Laboratory | 820 S Mcclellan St Ste Ll10, Spokane, WA 99204-2446 | 2012-12-07 |
1881907715 | Providence Health & Services Washington | Internal Medicine | 62 W 7th Ave, Spokane, WA 99204-2321 | 2010-07-20 |
1073744850 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 2505 Olympic Hwy N., Ste 140, Shelton, WA 98584-2978 | 2009-07-28 |
1770714693 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 508 1/2 Eighth Street, Hoquiam, WA 98550-3521 | 2009-07-28 |
1033309604 | Providence Health & Services Washington | Family Medicine | 1450 Northwest Lane Se, Lacey, WA 98503-6908 | 2007-07-30 |
Street Address |
4800 COLLEGE ST SE |
City | LACEY |
State | WA |
Zip Code | 98503-4389 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457339319 | Sandra Loyer | Physician Assistant | 4800 College St Se, Lacey, WA 98503-4389 | 2006-01-02 |
1114568540 | Karen Lee Newman | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2019-10-07 |
1124674965 | Michaela Jane De Groot | Physical Therapist | 4800 College St Se, Lacey, WA 98503-4389 | 2019-08-16 |
1912475666 | Andrew Thomas | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2018-11-09 |
1487151577 | Tana Russell | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2018-04-06 |
1215431697 | Providence Health & Services Washington | Clinic/Center | 4800 College St Se, Lacey, WA 98503-4389 | 2018-03-21 |
1194229732 | Joanne Marie Mulder | Physician Assistant | 4800 College St Se, Lacey, WA 98503 | 2018-03-20 |
1467986802 | Danilynn Benavente | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-04-12 |
1245761675 | Sophia Stanley | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-03-27 |
1992236814 | Virginia Harris | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-03-22 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457838989 | Michele Nordgren Bourque | Psychologist | 4329 Concordia Lane Se, Lacey, WA 98503 | 2018-07-26 |
1831638675 | Trevor John Marum | Chiropractor | 3945 8th Ave Se, Lacey, WA 98503 | 2017-02-13 |
1366993362 | Vanessa Julie Iglesias Mehta | Physician Assistant | 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 | 2016-10-14 |
1144683616 | Millenda Thomas | Registered Nurse | 1233 Firpark Dr. S.e., Lacey, WA 98503 | 2016-04-01 |
1609257245 | Erika Charlotte Vonkotzebue | Counselor | 4401 37th Ave. Se #25, Lacey, WA 98503 | 2015-06-09 |
1437576196 | Candy Nelson | Registered Nurse | 4410 6th Ave Se, Apt# 115, Lacy, WA 98503 | 2014-03-19 |
1134563919 | Alvin Fitzgerald | Pharmacist | 665 Sleater Kinney Rd., S.e, Target Pharmacy #1355, Lacey, WA 98503 | 2013-04-23 |
1518200724 | Katherine Mary Marsh | Psychologist | 5191 Corporate Center Court Se, Lacey, WA 98503 | 2013-04-05 |
1740530906 | Leanna Marie Mcbroom | Massage Therapist | 1608 Diamond Loop Se, Lacey, WA 98503 | 2012-09-14 |
1831445196 | Joyce Emily Christensen Coniff | Counselor | 5706 39th Ave Se., Lacey, WA 98503 | 2012-07-24 |
Find all providers in zip 98503 |
Taxonomy Code | 261QR0405X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Rehabilitation, Substance Use Disorder |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1467857904 | Olympic Recovery Center LLC | Clinic/Center | 8645 Martin Way E # 100, Lacey, WA 98516-5851 | 2014-10-27 |
1659562221 | The Right Step, Inc. | Clinic/Center | 801 Sleater Kinney Rd Se Ste 20, Lacey, WA 98503-1137 | 2007-08-07 |
1215383138 | Royal Life Centers, LLC | Clinic/Center | 8645 Martin Way E, Lacey, WA 98516-5851 | 2016-05-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275145682 | Sea Mar Community Health Centers | Clinic/Center | 4100 194th St Sw Ste 120, Lynnwood, WA 98036-4613 | 2020-08-18 |
1386278372 | Social Treatment Opportunity Programs II, Inc | Clinic/Center | 600 S 1st Ave, Othello, WA 99344-1703 | 2020-02-27 |
1326672692 | Excelsior Integrated Care Center LLC | Clinic/Center | 3910 W. Indian Trail Rd, Spokane, WA 99208-4739 | 2020-02-26 |
1659919561 | Baart Behavioral Health Services, Inc. | Clinic/Center | 716 S Chase St, Port Angeles, WA 98362-6122 | 2019-12-11 |
1346888260 | Baart Behavioral Health Services, Inc. | Clinic/Center | 1520 Ne Riddell Rd Ste 110, Bremerton, WA 98310-3005 | 2019-12-11 |
1437634730 | Hazelden Betty Ford Foundation | Clinic/Center | 1231 116th Ave. Ne Suite 410, Bellevue, WA 98004 | 2018-10-02 |
1780174441 | American Behavioral Health Systems, Inc. | Clinic/Center | 715 E Sprague Ave Ste 107, Spokane, WA 99202-2142 | 2018-05-17 |
1598255267 | American Behavioral Healt Systems, Inc. | Clinic/Center | 7208 267th St Nw Ste A-100, Stanwood, WA 98292-6289 | 2018-05-17 |
1437648136 | American Behavioral Health Systems, Inc. | Clinic/Center | 8625 Evergreen Way Ste 100, Everett, WA 98208-2620 | 2018-05-08 |
1487143350 | Steve Parker | Clinic/Center | 1206 State Ave Ste H, Marysville, WA 98270-3645 | 2018-05-07 |
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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.