PROVIDENCE HEALTH & SERVICE - WASHINGTON (NPI# 1811942758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811942758 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICE - WASHINGTON |
| Other Organization Name | PROVIDENCE IMAGING CENTER |
| Practice Address |
908 S Scheuber Rd Centralia WA 98531-9027 |
| Mailing Address |
Po Box 34439 Seattle WA 98124-1439 |
| Practice Telephone | 3603308880 |
| Practice Fax Number | 3603308812 |
| Mailing Telephone | 4255256778 |
| Mailing Fax Number | 4255256700 |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2010-12-22 |
| Authorized Official Name | NICOLE QUINN (PAYOR CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4255256715 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2471B0102X |
Radiologic Technologist Specialization: Bone Densitometry |
Technologists, Technicians & Other Technical Service Providers | ||
| N | 2471M2300X |
Radiologic Technologist Specialization: Mammography |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 2471C3402X |
Radiologic Technologist Specialization: Radiography |
Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7124043 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Imaging Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003009259 | Providence Health & Service - Washington | Internal Medicine | 2015 Cooks Hill Rd, Suite 200, Centralia, WA 98531-9074 | 2007-08-21 |
| 1013100262 | Providence Health & Service - Washington | Internal Medicine | 4525 3rd Ave Se, Suite 200, Lacey, WA 98503-1010 | 2007-08-21 |
| 1558554709 | Providence Health & Service - Washington | Internal Medicine | 954 Anderson Dr, Suite 102, Aberdeen, WA 98520-1001 | 2007-08-21 |
| Street Address |
908 S SCHEUBER RD |
| City | CENTRALIA |
| State | WA |
| Zip Code | 98531-9027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528267804 | Providence Health & Services - Washington | Clinic/Center | 908 S Scheuber Rd, Centralia, WA 98531-9027 | 2007-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306462205 | Jelisa Renae Thomas | Counselor | 3510 Steelhammer Ln, Centralia, WA 98531 | 2020-06-17 |
| 1205498607 | Jennifer Kristine Mcglynn Paterno | Counselor | 2428 W. Reynods Ave, Centralia, WA 98531 | 2019-07-05 |
| 1538646328 | Adam Jeffrey Moore | Counselor | 3510 Steelhammer Lane, Centralia, WA 98531 | 2018-07-24 |
| 1144706698 | Euijeong Kim | Occupational Therapist | Rehabilitation Therapies, 914 S. Scheuber Rd, Centralia, WA 98531 | 2018-07-18 |
| 1104315266 | Margaret Fowler Floyd | Registered Nurse | Centralia High School, 813 Eshom Road, Centralia, WA 98531 | 2018-05-04 |
| 1124545777 | Samantha Michelle Moody | Speech-Language Pathologist | Centralia School District, 2320 Borst Ave, Centralia, WA 98531 | 2017-08-24 |
| 1821520289 | Alexa Franks | Behavior Technician | 2428 West Reynolds Ave., Centralia, WA 98531 | 2017-04-03 |
| 1023559861 | Brandy Michelle Peterson | Counselor | 135 W. Main Steet, Centralia, WA 98531 | 2017-03-13 |
| 1841738812 | Graceful Healing Naturopathic | Naturopath | 219 N Tower Ave, Suite 304, Centralia, WA 98531 | 2017-02-09 |
| 1043681513 | Angela Naillon | Counselor | 2428 West Reynolds, Centralia, WA 98531 | 2015-10-09 |
| Find all providers in zip 98531 | ||||
| Taxonomy Code | 2471C3402X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| Specialization | Radiography |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508311366 | Ramanpreet Dhaliwal | Radiologic Technologist | 10615 Se 256th St, Ste 101, Kent, WA 98030-6809 | 2016-08-22 |
| 1013233782 | Scott A Yount | Radiologic Technologist | Msron Nine 2000 W Marine View Dr, Everett, WA 98207-0001 | 2010-04-20 |
| 1215160221 | Andrew John Leyva | Radiologic Technologist | 701 5th Ave Ste 213, Seattle, WA 98104-7033 | 2009-08-25 |
| 1679610356 | Russ K Reynolds | Radiologic Technologist | 220 25th St Ne, East Wenatchee, WA 98802-4097 | 2007-01-31 |
| 1255951661 | Genevieve Hill | Radiologic Technologist | 325 9th Ave, Seattle, WA 98104-2420 | 2020-04-26 |
| 1740800143 | Jennifer Kuang | Radiologic Technologist | 325 9th Ave, Seattle, WA 98104-2499 | 2020-04-26 |
| 1376163774 | Renee Jackson | Radiologic Technologist | 325 9th Ave, Seattle, WA 98104-2499 | 2020-04-26 |
| 1073985057 | Bryan James Antonius | Radiologic Technologist | 10004 204th Ave E, Suite 2600, Bonney Lake, WA 98391-6539 | 2015-10-29 |
| 1710312772 | Alma Miller | Radiologic Technologist | 1660 S Columbian Way, Seattle, WA 98108-1532 | 2013-09-10 |
| 1114060001 | Antoine Tahkeal | Radiologic Technologist | 401 Buster Rd, Toppenish, WA 98948-9792 | 2007-02-14 |
| 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.