PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI# 1750560488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750560488 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES WASHINGTON |
| Other Organization Name | PROVIDENCE ST PETER HOSPITAL |
| Practice Address |
413 Lilly Rd Ne Olympia WA 98506-5133 |
| Mailing Address |
Po Box 3505 Portland OR 97208-3505 |
| Practice Telephone | 3604919480 |
| Mailing Telephone | 4255256717 |
| Mailing Fax Number | 4255256700 |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2017-10-30 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (DIRECTOR REIMBURSEMENT ADMINISTRATI) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QH0002X |
Family Medicine Specialization: Hospice and Palliative Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207RH0002X |
Internal Medicine Specialization: Hospice and Palliative Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7135932 | 05 | |
| WA | L&I CRIME VICTIMS | 8901337 | 01 |
| WA | L&I | 129210 | 01 |
| Other Name | Type Code |
|---|---|
| Providence St Peter Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134656135 | Providence Health & Services Washington | Clinic/Center | 1018 Capitol Way S Ste 300, Olympia, WA 98501-1212 | 2017-05-22 |
| 1023550050 | Providence Health & Services Washington | Psychologist | 225 State Ave Ne, Olympia, WA 98501-6951 | 2016-11-08 |
| 1003367863 | Providence Health & Services Washington | Radiology | 4800 College St Se Ste E, Lacey, WA 98503-4389 | 2016-10-17 |
| 1023563897 | Providence Health & Services Washington | Clinic/Center | 1705 Se Meadowbrook Blvd, Suite 2, College Place, WA 99324-1756 | 2016-08-22 |
| 1457721250 | Providence Health & Services Washington | Clinic/Center | 1200 Basich Blvd, Aberdeen, WA 98520-1035 | 2015-10-06 |
| 1902141500 | Providence Health & Services Washington | Clinical Medical Laboratory | 820 S Mcclellan St Ste Ll10, Spokane, WA 99204-2446 | 2012-12-07 |
| 1881907715 | Providence Health & Services Washington | Internal Medicine | 62 W 7th Ave, Spokane, WA 99204-2321 | 2010-07-20 |
| 1073744850 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 2505 Olympic Hwy N., Ste 140, Shelton, WA 98584-2978 | 2009-07-28 |
| 1770714693 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 508 1/2 Eighth Street, Hoquiam, WA 98550-3521 | 2009-07-28 |
| 1033309604 | Providence Health & Services Washington | Family Medicine | 1450 Northwest Lane Se, Lacey, WA 98503-6908 | 2007-07-30 |
| 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 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 98506 | ||||
| Taxonomy Code | 207RH0002X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hospice and Palliative Medicine |
| An internal medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family. This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care. |
| Notes: Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952689077 | Matthew W Louie | Internal Medicine | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2011-07-22 |
| 1104014364 | Sarah B Merrifield | Internal Medicine | 413 Lilly Rd Ne, Palliative Care, Olympia, WA 98506-5133 | 2007-10-11 |
| 1245341106 | Bonnie V Baker | Internal Medicine | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669975280 | Mid-south Home Care Services, LLC | Internal Medicine | 22820 E Appleway Ave Ste C, Liberty Lake, WA 99019-9514 | 2018-03-09 |
| 1609843382 | Karen Knops | Internal Medicine | 1035 116th Ave Ne, Bellevue, WA 98004-4604 | 2006-03-02 |
| 1851373799 | Laura Schellenberg Johnson | Internal Medicine | 12040 Ne 128th St # Ms 105, Kirkland, WA 98034-3013 | 2005-11-16 |
| 1043637408 | Nauzley Christy Abedini | Internal Medicine | 325 9th Ave, Seattle, WA 98104-2420 | 2014-03-24 |
| 1003133760 | Providence Physician Services Co | Internal Medicine | 101 W 8th Ave, Center for Faith and Healing, Spokane, WA 99204-2307 | 2010-04-21 |
| 1952537565 | Kathryn Ann Vogelsang Schlenker | Internal Medicine | 1959 Ne Pacific St, Box 356390, Seattle, WA 98195-0001 | 2009-06-09 |
| 1346432721 | Tula Top | Internal Medicine | 2211 Ne 139th St, Vancouver, WA 98686-2742 | 2007-08-09 |
| 1093906026 | Caroline Jeanette Hurd | Internal Medicine | 325 9th Ave, Seattle, WA 98104-2420 | 2007-08-06 |
| 1477751139 | Meredith Blayne Brass | Internal Medicine | 12822 124th Ln Ne, Kirkland, WA 98034-7612 | 2007-07-04 |
| 1013075605 | Christine Cofer | Internal Medicine | 2901 Bridgeport Way W, University Place, WA 98466-4614 | 2006-12-05 |
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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.