PROVIDENCE HEALTH & SERVICES (NPI# 1902110497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902110497 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES |
| Other Organization Name | PROVIDENCE SPOKANE HEART INSTITUTE-DEER PARK FAMILY CARE CLINIC |
| Practice Address |
905 East D Street Deer Park WA 99006-0000 |
| Mailing Address |
Po Box 3776 Seattle WA 98124-3776 |
| Practice Telephone | 5092765005 |
| Mailing Telephone | 4255256798 |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2010-11-08 |
| Authorized Official Name | KAREN DUNCAN (SR. DIRECTOR OF REVENUE MGT) |
| Authorized Official Telephone | 4252545362 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Providence Spokane Heart Institute-Deer Park Family Care Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609322528 | Providence Health & Services | In Home Supportive Care | 110 S. Third Street E., Chewelah, WA 99109 | 2016-08-31 |
| 1811201312 | Providence Health & Services | Internal Medicine | 715 S Washington, Suite A, Moscow, ID 83843-0000 | 2010-07-27 |
| 1720391659 | Providence Health & Services | Internal Medicine | 629 Jasmine St, Omak, WA 98841 | 2010-07-20 |
| 1114230042 | Providence Health & Services | Internal Medicine | 318 E Rowan Ave, 240, Spokane, WA 99207-1200 | 2010-07-20 |
| 1154539203 | Providence Health & Services | Internal Medicine | 1510 Division St Ste 200, Oregon City, OR 97045-1599 | 2007-05-21 |
| 1780742114 | Providence Health & Services | Internal Medicine | 1515 Portland Rd, Newberg, OR 97132-1844 | 2006-12-05 |
| 1831639731 | Providence Health & Services | Home Health Aide | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2017-02-27 |
| 1093056632 | Providence Health & Services | General Acute Care Hospital | 6801 Coldwater Canyon Ave, Suite 1a, North Hollywood, CA 91605-5162 | 2013-03-06 |
| 1689977159 | Providence Health & Services | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 700 W Ironwood Dr, Suite 350, Coeur D Alene, ID 83814-2656 | 2010-12-06 |
| 1245544584 | Providence Health & Services | Internal Medicine | 1550 S Pioneer Way, Pioneer Medical Center #250, Moses Lake, WA 98837-4613 | 2010-07-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | PROVIDENCE HEALTH & SERVICES | 1801 Lind Ave Sw #9016, Renton, WA 98057 |
| Washington State Corporations | PROVIDENCE HEALTH & SERVICES | 1801 Lind Ave Sw #9016, Renton, WA 98057 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE HEALTH & SERVICES - MONTANA | 1801 Lind Ave Sw, Renton, WA 98057 |
| Colorado Business Entities | Providence Health & Services - Montana | Dept of Legal Affairs, 1801 Lind Ave. Sw, Renton, WA 98057 |
| Washington State Corporations | PROVIDENCE HEALTH & SERVICES - MONTANA | 1801 Lind Ave Sw, Renton, WA 98057-3368 |
| Colorado Business Entities | Providence Health & Services - Oregon | 1801 Lind Avenue, Sw, Renton, WA 98057-9016 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave Sw #9016, Renton, WA 98057 |
| System for Award Management (SAM) Entities | PROVIDENCE HEALTH & SERVICES - OREGON | 4400 Ne Halsey St Bldg 2 Ste 690, Portland, OR 97213-1545 |
| Iowa Business Entities | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave. Sw, Renton, WA 98057 |
| Washington State Corporations | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave Sw # 9016, Renton, WA 98057 |
| Street Address |
905 EAST D STREET |
| City | DEER PARK |
| State | WA |
| Zip Code | 99006-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558367961 | Julie A Moran | Family Medicine | 905 East D Street, Deer Park, WA 99006-1529 | 2005-06-22 |
| 1518134964 | Jillian Rae Foglesong Stabile | Family Medicine | 905 East D Street, Deer Park, WA 99006 | 2008-05-14 |
| 1790959971 | Jonathan James Wilson | Family Medicine | 905 East D Street, Deer Park, WA 99006-1529 | 2008-04-17 |
| 1073685285 | Derek Hennessy | Physician Assistant | 905 East D Street, Deer Park, WA 99006 | 2006-11-14 |
| 1689611519 | Karen D. Bichler | Nurse Practitioner | 905 East D Street, Deer Park, WA 99006 | 2006-05-31 |
| 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 | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477984391 | Frank Pollaro, M.d., P.C. | Internal Medicine | 353 Baldwin Path, Deer Park, NY 11729-1413 | 2013-12-02 |
| 1073797981 | Comprehensive Medical PC | Internal Medicine | 1649 Deer Park Ave, Deer Park, NY 11729-5202 | 2007-12-27 |
| 1003976077 | Kevin S Lee | Internal Medicine | 1649 Deer Park Avenue, Deer Park, NY 11729 | 2006-12-11 |
| 1992729925 | Jerry A. Sokol | Internal Medicine | 1630 Deer Park Ave, Deer Park, NY 11729-5210 | 2006-07-26 |
| 1730168246 | Sinan Kadayifci | Internal Medicine | 1644 Deer Park Ave, Suite Lower Level North, Deer Park, NY 11729-5211 | 2006-01-12 |
| 1568760072 | Suffolk Cardiovascular Consultants PC | Internal Medicine | 1920 Deer Park Ave, Suite 104, Deer Park, NY 11729-3314 | 2011-03-08 |
| 1235392036 | Heart and Vascular Consulting of Long Island, PC | Internal Medicine | 1630 Deer Park Ave, Deer Park, NY 11729-5210 | 2008-07-02 |
| 1588846703 | Suffolk Cardiovascular Consultants, Pllc | Internal Medicine | 1920 Deer Park Ave, Suite 104, Deer Park, NY 11729-3314 | 2007-11-29 |
| 1912197104 | American Heart Medical Services LLC | Internal Medicine | 1644 Deer Park Ave, Suite Lower Level North, Deer Park, NY 11729-5211 | 2007-07-25 |
| 1528267523 | Lance Scott Lefkowitz | Internal Medicine | 1630 Deer Park Ave, Deer Park, NY 11729-5210 | 2007-07-11 |
| Find all providers in DEER PARK | ||||
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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.