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PROVIDENCE HEALTH & SERVICES - WA NPI 1063663458


NPI Information

NPI: 1063663458
Provider Name: PROVIDENCE HEALTH & SERVICES - WA

Doing Business As: PMG NW WA MARYSVILLE CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 50D0716767

Address:
11603 STATE AVE
SUITE G
MARYSVILLE, WA
ZIP 98271
Phone: (360) 658-6800
Get Directions

PROVIDENCE HEALTH & SERVICES - WA is a family medicine in Marysville, 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 1063663458. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Pmg Nw Wa Marysville Clinic.

The provider's business location address is:

11603 STATE AVE
SUITE G
MARYSVILLE, WA
ZIP 98271-465
Phone: (360) 658-6800
Fax: (360) 658-6819

The provider's authorized official is Donald Wayne Anderson .
The authorized official title is Director Reimb Regulatory Strategy and has the following contact phone number (425) 525-5392.

The CLIA number assigned to this NPI record is 50D0716767 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/4/2008 and was last updated on 3/11/2021.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineNo
2208000000XPediatricsNo
3208D00000XGeneral PracticeNo
4332B00000XDurable Medical Equipment & Medical SuppliesNo
5207Q00000XFamily MedicineYes

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.