Organization · Type 2 NPI

Providence Health & Services Washington

Diagnostic Radiology Physician · Lacey, WA

NPI number 1003367863 Active

Practice location

4800 College St SE Ste E
Lacey, WA 98503-4389

Call (360) 489-2960 Map

Fax (360) 489-2961

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110

Specialties and licenses

Taxonomy	Code	License
Diagnostic Radiology Physician Primary	2085R0202X	None listed

Diagnostic Radiology Physician: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Other diagnostic radiology physician providers in Lacey

Olympia Open Mri LLCDiagnostic Radiology Physician Lacey, WA NPI 1073573820

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NPI record

NPI: 1003367863
Entity type: Organization (Type 2)
Issued: Oct 17, 2016
Last updated: May 13, 2025
Status: Active

Other names

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Providence ST Peter Hospital Diagnostic Imaging Lacey · other name

Authorized official

Donald Wayne Anderson
Assistant Secretary for Enrollment
(425) 358-9786

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1003367863

Providence Health & Services Washington's National Provider Identifier is 1003367863, issued on Oct 17, 2016. The primary taxonomy on file is Diagnostic Radiology Physician (2085R0202X), and the practice location is in Lacey, WA. The record was last updated on May 13, 2025.