OrganizationProvidence Health & Services - Washington(<Unavail>)Internal MedicineAllopathic & Osteopathic PhysiciansPractice Address1330 Rockefeller Ave, Suite 230, Everett, WA 98201-1676(425) 261-4925(425) 358-9786PECOS EnrollmentBased on the most recent information from CMS, provider Providence Health & Services - Washington does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1902057029Provider TypeOrganizationFull NameProvidence Health & Services - WashingtonOther Name<Unavail>SubpartNoEnumeration Date10/7/2008Last Updated5/14/2025Contact InformationPractice LocationPractice Address1330 Rockefeller Ave, Suite 230, Everett, WA 98201-1676Phone(425) 261-4925Fax(425) 261-4932Mailing LocationMailing AddressPO Box 31001-4114, Pasadena, CA 91110-4114Phone(425) 358-9786FaxUnlisted FaxAuthorized OfficialNameAnderson, Donald Wayne (Assistant Secretary Of Enrollments)Phone(425) 358-9786Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode2471B0102XDescriptionRadiologic TechnologistTechnologists, Technicians & Other Technical Service ProvidersLicenseUnlisted IssuerCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerCode363LG0600XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer