Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Health & Services Washington

Organization Diagnostic Radiology Physician · NPI 1003367863

Providence Health & Services Washington is a Diagnostic Radiology Physician in Lacey, Washington. Registered with an NPI since 2016.

In the registry since
2016

Practice location Address checks out

4800 College St SE Ste E
Lacey, WA 98503-4389
Phone: (360) 489-2960
Fax: (360) 489-2961
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X

Record details

NPI number1003367863
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secretary For Enrollment · (425) 358-9786
Other names Providence St Peter Hospital Diagnostic Imaging Lacey
NPI enumeratedOctober 17, 2016
Last updated in NPPESMay 13, 2025
Certification dateMay 13, 2025
Mailing addressPo Box 31001-4110, Pasadena, CA 91110-4110

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