PROVIDENCE ST. PETER HOSPITAL (NPI# 1497048615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497048615 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE ST. PETER HOSPITAL |
| Other Organization Name | PROVIDENCE ST. PETER HOSPITAL PAC LAB |
| Practice Address |
413 Lilly Rd Ne Olympia WA 98506-5133 |
| Mailing Address |
Po Box 2670 Spokane WA 99220-2670 |
| Practice Telephone | 8007528994 |
| Mailing Telephone | 8007528994 |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2011-05-20 |
| Authorized Official Name | MR. KURT ROGERS (CFO) |
| Authorized Official Telephone | 5097558700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 3302601 | 05 |
| Other Name | Type Code |
|---|---|
| Providence St. Peter Hospital PAC LAB | Doing Business As Name - Organization |
| Street Address |
413 LILLY RD NE |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-5133 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437157674 | Michael J Menen | Internal Medicine | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2005-07-12 |
| 1558962209 | Anieska Timms | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-11-07 |
| 1134737653 | Ngoc-van Thi Tran | Speech-Language Pathologist | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-07-21 |
| 1780292714 | Paola Von Oelffen | Student in an Organized Health Care Education/Training Program | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-07-15 |
| 1013542885 | Raffy Jatamosa | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-03-11 |
| 1811522766 | Kaman Lindgren | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-03-10 |
| 1497389886 | Phuong Le | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-02-25 |
| 1679107239 | Tamara Eklund | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-02-23 |
| 1598307878 | Alisa Singratanakul | Pharmacist | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2019-10-08 |
| 1528615192 | Anh Phuong Ho | Pharmacist | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2019-08-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
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| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326525023 | Cellnetix Labs, LLC | Clinical Medical Laboratory | 413 Lilly Rd Ne # Ddh06, Olympia, WA 98506-5133 | 2018-07-25 |
| 1558875369 | Laboratory Corporation of America | Clinical Medical Laboratory | 3525 Ensign Rd Ne Ste C, Olympia, WA 98506-5065 | 2017-12-01 |
| 1053682864 | Quest Diagnostics Clinical Laboratories Inc | Clinical Medical Laboratory | 315 Cooper Point Rd Nw, Ste 103, Olympia, WA 98502-4446 | 2012-01-25 |
| 1386920973 | Quest Diagnostics Clinical Laboratories Inc | Clinical Medical Laboratory | 420 Lilly Road Ne, Suite 101, Olympia, WA 98506-5132 | 2011-10-26 |
| 1740445949 | Dynacare Northwest Inc. | Clinical Medical Laboratory | 3425 Ensign Rd Ne Ste 250c, Olympia, WA 98506-5425 | 2008-07-28 |
| 1952815763 | Laboratory Corporation of America | Clinical Medical Laboratory | 3425 Ensign Rd Ne Ste 250, Olympia, WA 98506-5063 | 2017-12-01 |
| 1972017788 | Laboratory Corporation of America | Clinical Medical Laboratory | 1620 Cooper Point Rd Sw, Olympia, WA 98502-5736 | 2017-12-01 |
| 1982074621 | Eclipse Medical Group, Inc. | Clinical Medical Laboratory | 3240 14th Ave Nw, Olympia, WA 98502-8509 | 2015-10-06 |
| 1942684501 | Laboratory Corporation of America | Clinical Medical Laboratory | 1100 Eastside St Se, Olympia, WA 98501-7304 | 2015-07-14 |
| 1558741223 | Laboratory Corporation of America | Clinical Medical Laboratory | 404 Yauger Way Sw Ste 100, Olympia, WA 98502-8152 | 2015-06-08 |
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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.