PROVIDENCE HEALTH & SERVICES - WASHINGTON (NPI# 1891046926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891046926 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP SOUTHEAST WASHINGTON RURAL HEALTH CLINIC |
| Practice Address |
380 Chase Avenue Pmg Se Wa Rural Health Clinic Walla Walla WA 99362-2924 |
| Mailing Address |
Po Box 34439 Mailing/credentialing Seattle WA 98124-1439 |
| Practice Telephone | 5095263333 |
| Practice Fax Number | 5095268402 |
| Mailing Telephone | 5095298905 |
| Mailing Fax Number | 5095268402 |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |
| Authorized Official Name | MICHAEL PARENTEAU (CHIEF FINANCIAL OFFICIER) |
| Authorized Official Telephone | 5095225890 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Providence Medical Group Southeast Washington Rural Health Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407162571 | Providence Health & Services - Washington | Internal Medicine | 510 E Amende Drive, Odessa, WA 99159-0000 | 2010-08-26 |
| 1841503034 | Providence Health & Services - Washington | Family Medicine | 18313 Paulsonst Sw, Suite A, Rochester, WA 98579-9262 | 2010-07-16 |
| 1083947709 | Providence Health & Services - Washington | Hospice Care, Community Based | 2731 Wetmore Ave Ste 500, Everett, WA 98201-3585 | 2009-09-14 |
| 1760636690 | Providence Health & Services - Washington | Neurological Surgery | 301 W Poplar Street, Ste 220, Walla Walla, WA 99362-2800 | 2008-11-05 |
| 1558512368 | Providence Health & Services - Washington | Home Health | 209 W Poplar St, Walla Walla, WA 99362 | 2008-10-10 |
| 1922259738 | Providence Health & Services - Washington | Internal Medicine | 380 Chase Avenue, Pmg Se Wa, Walla Walla, WA 99362-2924 | 2008-10-10 |
| 1306097126 | Providence Health & Services - Washington | Radiology | 401 W Poplar Street, Pmg Se Wa Imaging, Walla Walla, WA 99362-2846 | 2008-10-10 |
| 1043374119 | Providence Health & Services - Washington | Rehabilitation, Substance Use Disorder Unit | 508 Quarter Eighth Street, Hoquiam, WA 98550 | 2006-12-21 |
| 1073677605 | Providence Health & Services - Washington | Rehabilitation, Substance Use Disorder Unit | 506 W Franklin St, Shelton, WA 98584-3517 | 2006-12-20 |
| 1003906918 | Providence Health & Services - Washington | Home Health | 3432 Bay Rd Ne, Olympia, WA 98506-2958 | 2006-10-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Health & Services - Washington | 1801 Lind Ave. Sw, #9016, Renton, WA 98057 |
| Street Address |
380 CHASE AVENUE PMG SE WA RURAL HEALTH CLINIC |
| City | WALLA WALLA |
| State | WA |
| Zip Code | 99362-2924 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922259738 | Providence Health & Services - Washington | Internal Medicine | 380 Chase Avenue, Pmg Se Wa, Walla Walla, WA 99362-2924 | 2008-10-10 |
| 1154672947 | Providence Health & Services - Washington | Internal Medicine | 380 Chase Avenue, Pmg Se Wa Rural Health Clinic, Walla Walla, WA 99362-2924 | 2012-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164065959 | Kevin Gia-minh Phan | Optometrist | Walla Walla Vamc Bldg 86, Walla Walla, WA 99362 | 2019-10-24 |
| 1659836401 | Arlene Lavonne Whitney | Social Worker | 1361 Dalles Military Road, Walla Walla, WA 99362 | 2019-02-06 |
| 1053880674 | Julie Ann Cooke | Speech-Language Pathologist | Providence St. Mary Medical Center, 401 W. Poplar St., Walla Walla, WA 99362 | 2018-11-14 |
| 1558887133 | Chantey Walker | Massage Therapist | 1840 Pleasant St, Walla Walla, WA 99362 | 2017-08-16 |
| 1447798723 | Carrie S Diede | Speech-Language Pathologist | 410 West Poplar Street, Rehabilitation Services, Walla Walla, WA 99362 | 2017-02-07 |
| 1235584103 | Anchor Point Counseling Pllc | Clinic/Center | 2330 Eastgate St. Ste. 140, Walla Walla, WA 99362 | 2016-04-28 |
| 1548627011 | Washington State Walla Walla Veterans Home | Skilled Nursing Facility | 92 Wainwright Drive, Walla Walla, WA 99362 | 2016-01-28 |
| 1073926200 | Sherry Goff | Registered Nurse | 11120 W Rose St, Family Medical Center, Walla Walla, WA 99362 | 2014-06-05 |
| 1538597935 | Michael Wade Gillespie | Orthopaedic Surgery | 101 Brookside Drive, Walla Walla, WA 99362 | 2013-10-22 |
| 1023357985 | Sandra Kay Bushnell | Speech-Language Pathologist | 1105 Isaacs Ave, Walla Walla, WA 99362 | 2013-02-12 |
| Find all providers in zip 99362 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346441979 | Walla Walla Clinic, Inc. | Clinic/Center | 55 W Tietan St, Walla Walla, WA 99362-4445 | 2007-05-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811555931 | Okanogan County Public Hospital Dist No 4 | Clinic/Center | 118 N Whitcomb Ave, Tonasket, WA 98855-8803 | 2019-06-04 |
| 1790204154 | Sunnyside Community Hospital Association | Clinic/Center | 715 N Park Ctr, Selah, WA 98942-1174 | 2017-09-15 |
| 1699215384 | Sunnyside Community Hospital Association | Clinic/Center | 505 W 4th Ave, Toppenish, WA 98948-1615 | 2017-03-01 |
| 1609112739 | Grant County Public Hospital District. No. 1 | Clinic/Center | 8420 Aspi Blvd, Moses Lake, WA 98837-1820 | 2012-12-18 |
| 1801188073 | Jefferson County Public Hospital District No 2 | Clinic/Center | 89 Breaker Ln, Port Ludlow, WA 98365-9766 | 2011-05-06 |
| 1255651907 | Family Care Network Pllc | Clinic/Center | 2511 M Ave Ste A, Anacortes, WA 98221-3897 | 2010-06-04 |
| 1871822676 | Public Hospital District 3 of Pacific County | Clinic/Center | 167 1st Avenue North, Ilwaco, WA 98624-0319 | 2009-12-08 |
| 1720276207 | Richard L. Dickson | Clinic/Center | 481 West E St, Forks, WA 98331 | 2007-10-09 |
| 1316138720 | L. Keith Hanson Pllc | Clinic/Center | 520 W. Indian Avenue, Brewster, WA 98812 | 2007-08-09 |
| 1407055742 | San Juan Healthcare PC | Clinic/Center | 689 Airport Center Dr Suite B, Friday Harbor, WA 98250 | 2007-07-17 |
| Find all providers with the same taxonomy | ||||
| City | WALLA WALLA |
| Zip Code | 99362 |
Please comment or provide details below to improve the information on PROVIDENCE HEALTH & SERVICES - WASHINGTON.
| 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.