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

Providence Health & Services - Washington

Organization Family Medicine Physician · NPI 1154672947

Providence Health & Services - Washington is a Family Medicine Physician in Walla Walla, Washington. Registered with an NPI since 2012.

In the registry since
2012
Specialties on file
4
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Practice location Address checks out

380 Chase Avenue Pmg SE Wa Rural Health Clinic
Walla Walla, WA 99362-2924
Phone: (509) 526-3333
Fax: (509) 526-8402
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Internal Medicine Physician Taxonomy 207R00000X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1154672947
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Health & Services Washington
Authorized official Donald Anderson — Assistant Secretary Of Enrollments · (425) 358-9786
Other names Providence Medical Group Southeast Washington Rural Health Clinic
NPI enumeratedSeptember 20, 2012
Last updated in NPPESMay 6, 2025
Certification dateMay 6, 2025
Mailing addressPo Box 34439, Pmg Se Wa Rural Health Clinic, Seattle, WA 98124-1439

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