PROVIDENCE HEALTHCARE (NPI# 1417148461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417148461 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTHCARE |
| Other Organization Name | DEER PARK HOSPITAL CRNA |
| Practice Address |
1015 E D St Deer Park WA 99006-5067 |
| Mailing Address |
910 N Washington St Suite 209 Spokane WA 99201-2202 |
| Practice Telephone | 5092321173 |
| Practice Fax Number | 5092321165 |
| Mailing Telephone | 5092765061 |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2007-10-30 |
| Authorized Official Name | DEBBIE L WICKLUND (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 5092321177 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NR1301X |
General Acute Care Hospital Specialization: Rural |
H 178 | WA | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | FACILITY ID | 000015 | 01 |
| WA | 9043233 | 05 | |
| WA | LICENSE | H 178 | 01 |
| Other Name | Type Code |
|---|---|
| DEER PARK HOSPITAL CRNA | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770856072 | Providence Healthcare | Home Health | 8505 Nw 74th St, Suite B, Miami, FL 33166-2327 | 2012-02-16 |
| 1720279953 | Providence Healthcare | General Acute Care Hospital | 1015 E D St, Deer Park, WA 99006-5067 | 2007-08-05 |
| 1174692289 | Providence Healthcare | Assisted Living Facility | 34 E 8th Ave, Spokane, WA 99202-7210 | 2006-11-06 |
| 1194917849 | Providence Healthcare | General Acute Care Hospital | 101 W 8th Ave, Spokane, WA 99204-2307 | 2007-08-16 |
| 1215128277 | Providence Healthcare | General Acute Care Hospital | 101 W 8th Ave, Spokane, WA 99204-2307 | 2007-08-06 |
| 1588855548 | Providence Healthcare | General Acute Care Hospital | 500 E Webster Ave, Chewelah, WA 99109-9523 | 2007-08-06 |
| 1225229289 | Providence Healthcare | General Acute Care Hospital | 500 E Webster Ave, Chewelah, WA 99109-9523 | 2007-08-06 |
| 1952592917 | Providence Healthcare | General Acute Care Hospital | 5633 N Lidgerwood St, Spokane, WA 99208-1224 | 2007-08-06 |
| 1861683823 | Providence Healthcare | General Acute Care Hospital | 5633 N Lidgerwood St, Spokane, WA 99208-1224 | 2007-08-06 |
| 1497946453 | Providence Healthcare | General Acute Care Hospital | 5633 N Lidgerwood St, Spokane, WA 99208-1224 | 2007-08-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Healthcare LLC | 4702 Ardley Drive, Colorado Springs, CO 80922 |
| Oklahoma Business Registrations | PROVIDENCE HEALTHCARE MANAGEMENT, LLC | 202 S Main, Po Box 1009, Gore, OK 74435 |
| System for Award Management (SAM) Entities | PROVIDENCE HEALTHCARE OF MS, LLC | 118 Levon Owens Dr, Terry, MS 39170-9696 |
| Street Address |
1015 E D ST |
| City | DEER PARK |
| State | WA |
| Zip Code | 99006-5067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720279953 | Providence Healthcare | General Acute Care Hospital | 1015 E D St, Deer Park, WA 99006-5067 | 2007-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417572892 | Deer Park Dental Pllc | Dentist | 118 E. Crawford St., Deer Park, WA 99006 | 2020-06-11 |
| 1124653464 | James Phelan | Optometrist | 14 N. Vernon Ave., Deer Park, WA 99006 | 2020-03-06 |
| 1336628841 | Shayla Michelle Simonson | Massage Therapist | West 114 South Avenue, Apt 4, Deer Park, WA 99006 | 2018-08-07 |
| 1710221494 | Lori Tetsuro Mcdonald | Hearing Instrument Specialist | 23 E Crawford St, Suite D, Deer Park, WA 99006 | 2012-11-19 |
| 1952675076 | Debra Kay Keller | Pharmacist | 412 S Main, Deer Park, WA 99006 | 2012-03-07 |
| 1457661027 | Martha Joan Haney | Massage Therapist | W 110 Crawford, Suite J, Deer Park, WA 99006 | 2010-10-18 |
| 1487818324 | Bi-mart Corporation | Durable Medical Equipment & Medical Supplies | 412 S. Main Avenue, Deer Park, WA 99006 | 2008-07-10 |
| 1912104498 | Melissa Ann Mccollough | Massage Therapist | 20 East J Street Suite B, Deer Park, WA 99006 | 2007-06-28 |
| 1336368182 | Community Health Association of Spokane | Clinic/Center | 401 S Main Street, Deer Park, WA 99006 | 2007-04-24 |
| 1215153739 | Bates and Miller, Pllc, Dds | Clinic/Center | 20 E J Street, Suite 2b, Deer Park, WA 99006 | 2007-04-17 |
| Find all providers in zip 99006 | ||||
| Taxonomy Code | 282NR1301X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Rural |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033470505 | Lewis County Hospital District No. 1 | General Acute Care Hospital | 521 Adams St, Morton, WA 98356-9323 | 2012-05-31 |
| 1073060380 | Team Health, Inc | General Acute Care Hospital | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2016-09-02 |
| 1124480561 | East Adams Rural Health Care | General Acute Care Hospital | 1407 E Thurston Ave, Spokane, WA 99203-4242 | 2016-03-24 |
| 1518378884 | Kvh | General Acute Care Hospital | 310 S Roosevelt Ave, Goldendale, WA 98620-9201 | 2014-05-08 |
| 1487904546 | Peacehealth | General Acute Care Hospital | 2901 Squalicum Parkway, Bellingham, WA 98225-1851 | 2012-09-17 |
| 1316182215 | Public Hospital District No 2 Skagit County Washington | General Acute Care Hospital | 1211 24th St, Anacortes, WA 98221-2557 | 2008-12-05 |
| 1225273121 | Public Hospital District No 2 Skagit County Washington | General Acute Care Hospital | 1211 24th St, Anacortes, WA 98221-2557 | 2008-12-05 |
| 1962406389 | Chelan County Public Hospital District No. 1 | General Acute Care Hospital | 817 Commercial St, Leavenworth, WA 98826-1316 | 2005-06-13 |
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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.