| 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 (DIRECTOR REIMBURSEMENT ADMINISTRATI) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health & Services Washington Po Box 3505 Portland OR 97208-3505 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 | 10/31/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063611408 | NPI | - | NPPES |
| 8919875 | Other | WA | L&I CRIME VICTIMS |
| 129210 | Other | WA | L&I |
| 7115611 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | H-159 (Washington) | Primary |
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Sweet Medical Group, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4524 Intelco Loop Se, Lacey, WA 98503 Phone: 360-491-9890 Fax: 360-667-5135 | |
Providence St Peter Internal Medi Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8645 Martin Way E, Bldg 2, Lacey, WA 98516 Phone: 360-923-4600 Fax: 360-923-4663 | |
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