PROVIDENCE PHYSICIAN SERVICES CO (NPI# 1619268281) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619268281 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
| Other Organization Name | PMG PROVIDENCE FAMILY MEDICINE CHEWELAH |
| Practice Address |
100 W. South Ave Chewelah Chewelah WA 99109 |
| Mailing Address |
Po Box 34439 Seattle WA 98124 |
| Practice Telephone | 5099358111 |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2011-04-29 |
| Authorized Official Name | MR. MICHAEL J MALLORY (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 6175041926 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PMG Providence Family Medicine Chewelah | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740566173 | Providence Physician Services Co | Internal Medicine | 212 Central Ave Suite 440, Spokane, WA 99208 | 2011-10-31 |
| 1295016145 | Providence Physician Services Co | Family Medicine | 801 W. 5th Ave, Suite 307, Spokane, WA 99204 | 2011-09-06 |
| 1184915829 | Providence Physician Services Co | Family Medicine | 5011 W. Lowell Ave, Seattle, WA 99208-8587 | 2011-04-28 |
| 1578869913 | Providence Physician Services Co | Family Medicine | 12704 E Nora Ave, Ste B, Spokane Valley, WA 99216-1140 | 2011-02-02 |
| 1891001277 | Providence Physician Services Co | Pediatrics | 5901 N Linderwood, Suite 126, Spokane, WA 99207 | 2010-08-24 |
| 1245557917 | Providence Physician Services Co | Obstetrics & Gynecology | 518 Clay Street, Chewelah, WA 99109 | 2010-04-21 |
| 1215223953 | Providence Physician Services Co | Prosthetic/Orthotic Supplier | 101 W 8th Ave, Mother Gamelin Center, 3rd Floor, Spokane, WA 99204-2307 | 2011-06-21 |
| 1336433812 | Providence Physician Services Co | Family Medicine | 104 W 5th Ave, Suite 390e, Spokane, WA 99204 | 2011-06-02 |
| 1053618892 | Providence Physician Services Co | Internal Medicine | 105 W 8th Ave, Ste 550e, Spokane, WA 99204-2302 | 2011-02-14 |
| 1356646202 | Providence Physician Services Co | Surgery | 122 W 7th Ave, Ste 420, Spokane, WA 99204-2349 | 2011-01-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | PROVIDENCE PHYSICIAN SERVICES CO. | 1801 Lind Ave Sw, Renton, WA 98057-3368 |
| Street Address |
100 W. SOUTH AVE CHEWELAH |
| City | CHEWELAH |
| State | WA |
| Zip Code | 99109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609322528 | Providence Health & Services | In Home Supportive Care | 110 S. Third Street E., Chewelah, WA 99109 | 2016-08-31 |
| 1639525157 | Shelley Gail Schreibman | Specialist | 101 N Park Street, Po, Chewelah, WA 99109 | 2016-05-13 |
| 1518361831 | David Stroyan | Pharmacist | 518 E Clay, New Health Programs, Chewelah, WA 99109 | 2014-10-15 |
| 1942554712 | Renee S Thompson | Psychologist | 208 E Clay St, Chewelah, WA 99109 | 2012-11-01 |
| 1356616759 | Paul Michael Cockerham | Physical Therapist | 101 N. Park St., Chewelah, WA 99109 | 2012-03-19 |
| 1669768479 | Lori S King | Veterinarian | 1505 N Pinebrook Dr, Chewelah, WA 99109 | 2011-06-21 |
| 1245557917 | Providence Physician Services Co | Obstetrics & Gynecology | 518 Clay Street, Chewelah, WA 99109 | 2010-04-21 |
| 1033340088 | Scott Anthony Lake | Dentist | 616 E Main, Chewelah, WA 99109 | 2009-08-06 |
| 1659560787 | Robin D Bowman | Counselor | 2264 C. Sand Canyon Road, Chewelah, WA 99109 | 2007-10-15 |
| 1225222888 | Deanna Dawn Norvell | Counselor | 106 S 2nd E, Chewelah, WA 99109 | 2007-08-28 |
| Find all providers in zip 99109 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528128907 | Kimberlyn Ann Johnstone | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-08 |
| 1346325750 | Thomas John Boone | Family Medicine | 410 E King Street, Chewelah, WA 99109-0137 | 2006-10-25 |
| 1720189749 | Paul Richard Larsen | Family Medicine | 100 W South Ave, Chewelah, WA 99019 | 2006-09-25 |
| 1124438338 | Caleb Christman Holtzer | Family Medicine | 100 W South Ave, Chewelah, WA 99109-9684 | 2014-04-28 |
| 1063632388 | Chewelah Associated Physicians | Family Medicine | 410 E King St, Chewelah, WA 99109 | 2007-04-27 |
| 1316167638 | Chewelah Associated Physicians | Family Medicine | 410 E King St, Chewelah, WA 99109 | 2007-04-27 |
| 1104971365 | Chewelah Associated Physicians Ps | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2007-01-25 |
| 1447310347 | James Gregory Sisco | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-11 |
| 1821158734 | Robin Nelson Moyer | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-11 |
| 1477654416 | Maja Zugec | Family Medicine | 518 E Clay Ave, Chewelah, WA 99109-8947 | 2006-09-25 |
| Find all providers in CHEWELAH | ||||
Please comment or provide details below to improve the information on PROVIDENCE PHYSICIAN SERVICES CO.
| 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.