Organization · Type 2 NPI

Providence Health & Services - Washington

Diagnostic Radiology Physician · Walla Walla, WA

NPI number 1306097126 Active

Practice location

401 W Poplar Street, Pmg SE Wa Imaging
Walla Walla, WA 99362-2846

Call (509) 522-5850 Map

Fax (509) 526-8402

Mailing address

PO Box 31001-4114
Pasadena, CA 91110-4114

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.

2 other providers at this address

Other diagnostic radiology physician providers in Walla Walla

See all in Walla Walla →

NPI record

NPI: 1306097126
Entity type: Organization (Type 2)
Issued: Oct 10, 2008
Last updated: May 6, 2025
Status: Active
Subpart: Yes of Providence Health & Services - Washington

Other names

<unavail>
Providence Medical Group Southeast Washington Imaging · doing business as

Authorized official

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.

Is this your record? How to update it.

About NPI 1306097126

Providence Health & Services - Washington's National Provider Identifier is 1306097126, issued on Oct 10, 2008. The primary taxonomy on file is Diagnostic Radiology Physician (2085R0202X), and the practice location is in Walla Walla, WA. The record was last updated on May 6, 2025.