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PROVIDENCE HEALTH & SERVICE - WASHINGTON NPI 1013100262


NPI Information

NPI: 1013100262
Provider Name: PROVIDENCE HEALTH & SERVICE - WASHINGTON

Doing Business As: PROV CENTRALIA INTERNAL MEDICINE

Classification: Internal Medicine - 207RX0202X
Entity Type: Organization

Specialization: Medical Oncology

Address:
4525 3RD AVE SE
SUITE 200
LACEY, WA
ZIP 98503
Phone: (360) 754-3934
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PROVIDENCE HEALTH & SERVICE - WASHINGTON is a medical oncology internal medicine in Lacey, WA. The provider is an internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. PROVIDENCE HEALTH & SERVICE - WASHINGTON NPI is 1013100262. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Prov Centralia Internal Medicine.

The provider's business location address is:

4525 3RD AVE SE
SUITE 200
LACEY, WA
ZIP 98503-010
Phone: (360) 754-3934
Fax: (360) 943-8023

The provider's authorized official is Nicole Quinn .
The authorized official title is Payor Credentialing Mananger and has the following contact phone number (425) 525-6715.

The enumeration date for this NPI number is 8/21/2007 and was last updated on 12/22/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RX0202XInternal MedicineMedical OncologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G8869645MEDICARE PINWASHINGTON
27139801MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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