PROVIDENCE PHYSICIAN GROUP (NPI# 1932270360) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932270360 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
12800 Bothell Everett Hwy Suite 260 Everett WA 98208-6642 |
| Mailing Address |
2940 W Marine View Dr Everett WA 98201-3926 |
| Practice Telephone | 4253165080 |
| Practice Fax Number | 4253165025 |
| Mailing Telephone | 4252587014 |
| Mailing Fax Number | 4252587760 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | EARL D. BEEGLE (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 4253165470 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| X | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| X | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| X | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| X | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
Allopathic & Osteopathic Physicians | ||
| X | 208200000X | Plastic Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7114101 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639258130 | Providence Physician Group | Clinic/Center | 12800 Bothell Everett Hwy, Suite 120, Everett, WA 98208-6642 | 2006-11-03 |
| 1073699922 | Providence Physician Group | Neurological Surgery | 2320 Rucker Ave, Suite A, Everett, WA 98201-2723 | 2006-10-31 |
| 1518040484 | Providence Physician Group | Radiologic Technologist | 14692 179th Ave Se, Suite 100, Monroe, WA 98272-1198 | 2006-10-23 |
| 1972686848 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 800, Monroe, WA 98272-1198 | 2006-10-23 |
| 1699858563 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 1330 Rockefeller Ave, Suite 220, Everett, WA 98201-1684 | 2006-10-23 |
| 1619050580 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 12800 Bothell Everett Hwy, Suite 180, Everett, WA 98208-6642 | 2006-10-23 |
| 1528141496 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 12800 Bothell Everett Hwy, Suite 190, Everett, WA 98208-6642 | 2006-10-23 |
| 1093896854 | Providence Physician Group | Radiologic Technologist | 12800 Bothell Everett Hwy, Suite 160, Everett, WA 98208-6644 | 2006-10-18 |
| 1225119050 | Providence Physician Group | Internal Medicine | 5007 Claremont Way, Everett, WA 98203-3321 | 2006-10-18 |
| 1548282189 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 900, Monroe, WA 98272-1198 | 2006-07-24 |
| Street Address |
12800 BOTHELL EVERETT HWY SUITE 260 |
| City | EVERETT |
| State | WA |
| Zip Code | 98208-6642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518963404 | James Daniel Bass | Family Medicine | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2005-06-24 |
| 1437620499 | Laboratory Corporation of America | Clinical Medical Laboratory | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2018-12-16 |
| 1306375563 | Coreyanne L Griffin | Counselor | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-06-09 |
| 1407389448 | Bushra Rahman | Internal Medicine | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-04-06 |
| 1831639731 | Providence Health & Services | Home Health Aide | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2017-02-27 |
| 1700325826 | Caroline Judd | Social Worker | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-02-22 |
| 1225485550 | Amy Barrows | Nurse Practitioner | 12800 Bothell Everett Hwy, Suite 120, Everett, WA 98208-6642 | 2016-05-17 |
| 1104299601 | Gary Dale Montgomery | Physician Assistant | 12800 Bothell Everett Hwy, Ste A, Everett, WA 98208-6642 | 2015-11-05 |
| 1457731556 | Laura Knapp | Counselor | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2015-06-03 |
| 1174903603 | Justin Gill | Nurse Practitioner | 12800 Bothell Everett Hwy, Everett, WA 98208 | 2015-05-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790270296 | Kenneth Britt Dyer | Registered Nurse | 10333 19th Ave, Se, Ste #109, Everett, WA 98208 | 2018-06-27 |
| 1518482215 | Glacier Peak Healthcare, Inc. | Home Health | 10530 19th Ave Se Ste 201, Everett, WA 98208 | 2017-08-03 |
| 1114454865 | Aliza Kreisman | Registered Nurse | 11020 19th Avenue Se, Kaiser Permanente of Washington Seattle Care Clinic, Everett, WA 98208 | 2017-05-12 |
| 1902269418 | Clay Eakin | Counselor | 2732 Grand Evenue, Everett, WA 98208 | 2016-04-01 |
| 1467810259 | Elizabeth Anne Powley | Marriage & Family Therapist | 1920 100th Street Southeast, Bld C3, Everett, WA 98208 | 2016-02-08 |
| 1659745842 | Andrea Rose Bedlington | Pharmacist | 11407 33rd Dr. Se, Everett, WA 98208 | 2015-11-25 |
| 1396123865 | Sound Surgeons Pllc | Clinic/Center | 125 130th Street Se, 1st Floor, Everett, WA 98208 | 2015-05-15 |
| 1831576537 | Chris Sturgeon | Counselor | 10102 Meridian Ave, Everett, WA 98208 | 2015-05-01 |
| 1982011128 | James M Lee | Physical Therapist | 10821 19th Ave Se Ste 102, Everett, WA 98208 | 2014-07-21 |
| 1972937357 | Ronald Tracy | Dentist | 10315 19th Avenue Se Suite 110, Everett, WA 98208 | 2013-08-21 |
| Find all providers in zip 98208 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568427623 | Linda S Gabourel | Dermatology | 4004 Colby Ave, Everett, WA 98201-6203 | 2006-04-19 |
| 1043294473 | Mark Conrad Valentine | Dermatology | 3327 Colby Ave, Everett, WA 98201-6403 | 2005-11-30 |
| 1336599208 | Teerawit Supakorndej | Dermatology | 4004 Colby Ave, Everett, WA 98201-6203 | 2016-06-21 |
| 1821356924 | Matthew Majerus | Dermatology | 4004 Colby Ave, Everett, WA 98201-6203 | 2012-04-25 |
| 1205135092 | Ge Zhao | Dermatology | 4004 Colby Ave, Everett, WA 98201-6203 | 2011-03-21 |
| 1912158023 | Providence Health & Services - Wa | Dermatology | 12800 Bothell Everett Hwy, Suite 260, Everett, WA 98208-6642 | 2008-10-07 |
| 1235394560 | Zarry Tavakkol | Dermatology | 4004 Colby Ave, Everett, WA 98201-6203 | 2008-07-25 |
| 1578720512 | Meredith Pierce Sheedy | Dermatology | 4004 Colby Ave, Everett, WA 98201-6203 | 2008-05-19 |
| 1649454026 | Michael L. Tjoelker, M.d. | Dermatology | 3327 Colby Ave, Everett, WA 98201-6403 | 2007-12-20 |
| 1275669459 | Susan Oldenkamp | Dermatology | 12811 8th Ave W, Suite D-109, Everett, WA 98204-6335 | 2007-02-24 |
| Find all providers in EVERETT | ||||
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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.