| Providence Health & Services Washington | |
|
420 Golf Club Rd Se Suite 203 Lacey WA 98503-1048 | |
| (360) 493-7469 | |
| (360) 459-2023 |
| Full Name | Providence Health & Services Washington |
|---|---|
| Speciality | Clinic/center |
| Location | 420 Golf Club Rd Se, Lacey, Washington |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY FOR ENROLLMENT) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health & Services Washington Po Box 31001-4110 Pasadena CA 91110-4110 Ph: (425) 525-6717 | Providence Health & Services Washington 420 Golf Club Rd Se Suite 203 Lacey WA 98503-1048 Ph: (360) 493-7469 |
| NPI Number | 1063611408 |
|---|---|
| Provider Enumeration Date | 07/16/2007 |
| Last Update Date | 03/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063611408 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | H-159 (Washington) | Primary |
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