| Providence St. Peter Hospital | |
|
413 Lilly Rd Ne Olympia WA 98506-5133 | |
| (360) 491-9480 | |
| (360) 483-5858 |
| Full Name | Providence St. Peter Hospital |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 413 Lilly Rd Ne, Olympia, Washington |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence St. Peter Hospital 909 N Broadway Pbo/credentialing Everett WA 98201-1409 Ph: (425) 317-0246 | Providence St. Peter Hospital 413 Lilly Rd Ne Olympia WA 98506-5133 Ph: (360) 491-9480 |
| NPI Number | 1508877689 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 04/18/2022 |
| Certification Date | 04/18/2022 |
| Medicare PECOS PAC ID | 7719873496 |
|---|---|
| Medicare Enrollment ID | O20041112000546 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508877689 | NPI | - | NPPES |
| HS60IP | Medicaid | AL | |
| 3302601 | Medicaid | WA | |
| ST0232 | Other | WA | REGENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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