PROVIDENCE HEALTH & SERVICES- WA NPI 1790014504

NPI Details

PROVIDENCE HEALTH & SERVICES- WA is a family medicine in Mill Creek, WA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PROVIDENCE HEALTH & SERVICES- WA NPI is 1790014504. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Pmg Nw Wa Mill Creek Commons.

The provider's business location address is:

16708 BOTHELL-EVERETT HIGHWAY
SUITE 201
MILL CREEK, WA
ZIP 98012-345
Phone: (425) 482-9020
Fax: (425) 482-9021

The provider's authorized official is Donald Wayne Anderson .
The authorized official title is Asst Sec For Enrollment/dir Reimb S and has the following contact phone number (425) 525-5392.

The CLIA number assigned to this NPI record is 50D2016034 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/8/2009 and was last updated on 4/16/2021.

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: