Organization · Type 2 NPI

Providence Health & Services Washington

General Practice Physician · College Place, WA

NPI number 1023563897 Active

Practice location

1705 SE Meadowbrook Blvd, Suite 2
College Place, WA 99324-1756

Call (509) 987-2450 Map

Mailing address

PO Box 32
Liberty Lake, WA 99019-0032

Specialties and licenses

Taxonomy	Code	License
General Practice Physician Primary	208D00000X	None listed
Clinic/Center	261Q00000X	None listed

General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

NPI record

NPI: 1023563897
Entity type: Organization (Type 2)
Issued: Aug 22, 2016
Last updated: May 6, 2025
Status: Active

Other names

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Providence Health & Services Washington (pmg Se Wa) - Express Care · doing business as

Authorized official

Mr. Donald W Anderson
Assistant Secretary of Enrollments
(425) 358-9786

Verify this record

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 1023563897

Providence Health & Services Washington's National Provider Identifier is 1023563897, issued on Aug 22, 2016. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in College Place, WA. The record was last updated on May 6, 2025.