Organization · Type 2 NPI

Providence Health & Services-Washington

Surgery Physician · Everett, WA

NPI number 1114236791 Active

Practice location

1330 Rockefeller Avenue, Suite 400
Everett, WA 98201-1676

Call (425) 261-4950 Map

Fax (425) 261-4951

Mailing address

PO Box 31001-4114
Pasadena, CA 91110-4114

Specialties and licenses

Taxonomy	Code	License
Surgery Physician Primary	208600000X	None listed

Surgery Physician: A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasin…

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NPI record

NPI: 1114236791
Entity type: Organization (Type 2)
Issued: Sep 30, 2010
Last updated: May 9, 2025
Status: Active

Other names

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PMG NW Wa Cardiovascular and Thoracic Surgery · doing business as
PMG NW Wa Cardiovascular and Thoracic Surgery · doing business as

Authorized official

Donald Wayne Anderson
Assistant Secretary of Enrollments
(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 1114236791

Providence Health & Services-Washington's National Provider Identifier is 1114236791, issued on Sep 30, 2010. The primary taxonomy on file is Surgery Physician (208600000X), and the practice location is in Everett, WA. The record was last updated on May 9, 2025.