PROVIDENCE HEALTHCARE (NPI# 1720279953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720279953 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTHCARE |
| Other Organization Name | DEER PARK HOSPITAL ER PHYSICIANS |
| 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 | 2007-08-05 |
| 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 | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
H 178 | WA | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | FACILITY ID | 000015 | 01 |
| WA | 7086051 | 05 | |
| WA | LICENSE | H 178 | 01 |
| Other Name | Type Code |
|---|---|
| DEER PARK HOSPITAL ER PHYSICIANS | 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 |
| 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 |
| 1417148461 | Providence Healthcare | General Acute Care Hospital | 1015 E D St, Deer Park, WA 99006-5067 | 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 |
| 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 |
|---|---|---|---|---|
| 1417148461 | Providence Healthcare | General Acute Care Hospital | 1015 E D St, Deer Park, WA 99006-5067 | 2007-08-06 |
| 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 | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396827424 | Providence Health Care | General Acute Care Hospital | E 1015 'd' Street, Deer Park, WV 99006-0742 | 2006-10-19 |
| 1417057233 | Providence Health Care | General Acute Care Hospital | 1015 East D Street, Deer Park, WA 99006-0742 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982157640 | University of Washington | General Acute Care Hospital | 140 W Florentia St Apt C, Seattle, WA 98119-2393 | 2016-07-29 |
| 1396199824 | Seattle Extracorporeal | General Acute Care Hospital | 925 Seneca Street, Seattle Extracorporeal, Seattle, WA 98101 | 2016-04-21 |
| 1487917233 | Peacehealth Peace Island Medical Center | General Acute Care Hospital | 1117 Spring Street, Friday Harbor, WA 98250-7303 | 2012-06-18 |
| 1699914226 | 633 | General Acute Care Hospital | 7244 237th Ave Ne, Redmond, WA 98053-7914 | 2009-02-04 |
| 1447413091 | Whidbey Island Public Hospital District | General Acute Care Hospital | 205 S Main Street, A, Coupeville, WA 98239 | 2008-07-03 |
| 1366609489 | Public Hospital District No 1 of Mason County | General Acute Care Hospital | 901 Mt View Dr Bldg 1, Shelton, WA 98584-4401 | 2008-05-16 |
| 1508911645 | Okanogan Douglas County Hospital Dist 1 | General Acute Care Hospital | 537 West Main, Brewster, WA 98812 | 2007-01-25 |
| 1801944038 | Us Veterns Hospital Pharmacy | General Acute Care Hospital | 611 Sw 1st Ct, Battle Ground, WA 98604-8424 | 2007-01-05 |
| 1164512083 | Grant County Public Hospital District #2 | General Acute Care Hospital | 908 Tenth Avenue Sw, Quincy, WA 98848 | 2006-10-13 |
| 1255429957 | Garfield County Memorial Hospital District | General Acute Care Hospital | 66 North 6th Street, Pomeroy, WA 99347-9705 | 2006-10-10 |
| Find all providers with the same taxonomy | ||||
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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.