Organization · Type 2 NPI

Providence Health & Services - Washington

Family Medicine Physician · Marysville, WA

NPI number 1063663458 Active

Practice location

11603 State Ave, Suite G
Marysville, WA 98271-8465

Call (360) 658-6800 Map

Fax (360) 658-6819

Mailing address

PO Box 31001-4114
Pasadena, CA 91110-4114

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	None listed
Internal Medicine Physician	207R00000X	None listed
Pediatrics Physician	208000000X	None listed
General Practice Physician	208D00000X	None listed
Durable Medical Equipment & Medical Supplies	332B00000X	None listed

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

4 other providers at this address

Other family medicine physician providers in Marysville

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NPI record

NPI: 1063663458
Entity type: Organization (Type 2)
Issued: Oct 4, 2008
Last updated: May 12, 2025
Status: Active

Other names

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PMG NW Wa Marysville Clinic · doing business as
PMG NW Wa Marysville Clinic · doing business as

Authorized official

Donald Wayne 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 1063663458

Providence Health & Services - Washington's National Provider Identifier is 1063663458, issued on Oct 4, 2008. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Marysville, WA. The record was last updated on May 12, 2025.