PROVIDENCE PHYSICIAN GROUP (NPI# 1639258130) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639258130 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
12800 Bothell Everett Hwy Suite 120 Everett WA 98208-6642 |
| Mailing Address |
909 N Broadway Everett WA 98201-1409 |
| Practice Telephone | 4253165150 |
| Practice Fax Number | 4253165153 |
| Mailing Telephone | 4253170257 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-11-21 |
| Authorized Official Name | EARL D. BEEGLE (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 4253165470 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7095367 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932270360 | Providence Physician Group | Dermatology | 12800 Bothell Everett Hwy, Suite 260, Everett, WA 98208-6642 | 2006-11-09 |
| 1073699922 | Providence Physician Group | Neurological Surgery | 2320 Rucker Ave, Suite A, Everett, WA 98201-2723 | 2006-10-31 |
| 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 |
12800 BOTHELL EVERETT HWY SUITE 120 |
| City | EVERETT |
| State | WA |
| Zip Code | 98208-6642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518963404 | James Daniel Bass | Family Medicine | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2005-06-24 |
| 1437620499 | Laboratory Corporation of America | Clinical Medical Laboratory | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2018-12-16 |
| 1306375563 | Coreyanne L Griffin | Counselor | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-06-09 |
| 1407389448 | Bushra Rahman | Internal Medicine | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-04-06 |
| 1831639731 | Providence Health & Services | Home Health Aide | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2017-02-27 |
| 1700325826 | Caroline Judd | Social Worker | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-02-22 |
| 1225485550 | Amy Barrows | Nurse Practitioner | 12800 Bothell Everett Hwy, Suite 120, Everett, WA 98208-6642 | 2016-05-17 |
| 1104299601 | Gary Dale Montgomery | Physician Assistant | 12800 Bothell Everett Hwy, Ste A, Everett, WA 98208-6642 | 2015-11-05 |
| 1457731556 | Laura Knapp | Counselor | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2015-06-03 |
| 1174903603 | Justin Gill | Nurse Practitioner | 12800 Bothell Everett Hwy, Everett, WA 98208 | 2015-05-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790270296 | Kenneth Britt Dyer | Registered Nurse | 10333 19th Ave, Se, Ste #109, Everett, WA 98208 | 2018-06-27 |
| 1518482215 | Glacier Peak Healthcare, Inc. | Home Health | 10530 19th Ave Se Ste 201, Everett, WA 98208 | 2017-08-03 |
| 1114454865 | Aliza Kreisman | Registered Nurse | 11020 19th Avenue Se, Kaiser Permanente of Washington Seattle Care Clinic, Everett, WA 98208 | 2017-05-12 |
| 1902269418 | Clay Eakin | Counselor | 2732 Grand Evenue, Everett, WA 98208 | 2016-04-01 |
| 1467810259 | Elizabeth Anne Powley | Marriage & Family Therapist | 1920 100th Street Southeast, Bld C3, Everett, WA 98208 | 2016-02-08 |
| 1659745842 | Andrea Rose Bedlington | Pharmacist | 11407 33rd Dr. Se, Everett, WA 98208 | 2015-11-25 |
| 1396123865 | Sound Surgeons Pllc | Clinic/Center | 125 130th Street Se, 1st Floor, Everett, WA 98208 | 2015-05-15 |
| 1831576537 | Chris Sturgeon | Counselor | 10102 Meridian Ave, Everett, WA 98208 | 2015-05-01 |
| 1982011128 | James M Lee | Physical Therapist | 10821 19th Ave Se Ste 102, Everett, WA 98208 | 2014-07-21 |
| 1972937357 | Ronald Tracy | Dentist | 10315 19th Avenue Se Suite 110, Everett, WA 98208 | 2013-08-21 |
| Find all providers in zip 98208 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609393297 | Byram Healthcare Centers, Inc. | Durable Medical Equipment & Medical Supplies | 6301 36th Ave W, Everett, WA 98203-1265 | 2017-08-24 |
| 1124475272 | Crane Hardware LLC | Durable Medical Equipment & Medical Supplies | 4610 Evergreen Way Ste 8, Everett, WA 98203-2872 | 2016-05-18 |
| 1861858086 | Washington Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 11918 Airport Rd, Everett, WA 98204-5509 | 2016-01-04 |
| 1821433558 | Performance Modalities Inc | Durable Medical Equipment & Medical Supplies | 3202 Colby Ave Ste D, Everett, WA 98201-4324 | 2013-05-08 |
| 1336466879 | Edward J Chesnutis, Dpm, Pllc | Durable Medical Equipment & Medical Supplies | 10305 19th Ave Se Ste A, Everett, WA 98208-4252 | 2010-04-23 |
| 1205097847 | Recovercare, LLC. | Durable Medical Equipment & Medical Supplies | 917 134th St Sw, Ste B4, Everett, WA 98204-9377 | 2008-06-17 |
| 1154505378 | African Initiative for Community Development, Inc | Durable Medical Equipment & Medical Supplies | 111 Boston St, Everett, MA 02149-4727 | 2007-12-24 |
| 1023298320 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 5802 134th Pl Se, Everett, WA 98208-9426 | 2007-11-05 |
| 1093876781 | Terri A Knudson | Durable Medical Equipment & Medical Supplies | 2909 Hewitt Avenue, Everett, WA 98201-3821 | 2006-12-13 |
| 1063586931 | Hanger Prosthetics & Orthotics West Inc | Durable Medical Equipment & Medical Supplies | 4009 Colby Ave, Everett, WA 98201-4928 | 2006-11-20 |
| Find all providers in EVERETT | ||||
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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.