PROVIDENCE HEALTH & SERVICE - WASHINGTON NPI 1003009259

Internal Medicine (Medical Oncology) in Centralia, WA

About PROVIDENCE HEALTH & SERVICE - WASHINGTON

Providence Health & Service - Washington is a provider in Centralia, WA. The NPI number assigned to this provider is 1003009259. The practitioner's primary taxonomy code is Internal Medicine (207RX0202X). The provider is registered as an organization and their NPI record was last updated 7 years ago. Providence Health & Service - Washington operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as Prov Centrlia Internal Medicine.

NPI1003009259 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NamePROVIDENCE HEALTH & SERVICE - WASHINGTON
Provider Location Address2015 COOKS HILL RD SUITE 200 CENTRALIA, WA 98531 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing AddressPO BOX 34439 SEATTLE, WA 98124 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Other Organization NamePROV CENTRLIA INTERNAL MEDICINE Additional informationCallout TooltipProvider other organization name
The alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. Codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Other Name TypeDoing Business As (3)
Enumeration Date08-21-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date12-22-2010 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

PROVIDENCE HEALTH & SERVICE - WASHINGTON
2015 COOKS HILL RD
SUITE 200
CENTRALIA, WA
ZIP 98531
Phone: (360) 330-8939
Fax: (360) 330-8916
Get Directions

Mailing Address

PROVIDENCE HEALTH & SERVICE - WASHINGTON
PO BOX 34439
SEATTLE, WA
ZIP 98124
Phone: (425) 525-6778
Fax: (425) 525-6700

Primary Taxonomy

Taxonomy Code207RX0202X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationMedical Oncology
Taxonomy DescriptionAn internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer.

Authorized Official

Authorized Official Name NICOLE QUINN Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitlePAYOR CREDENTIALING MANAGER
Authorized Official Phone(425) 525-6715

193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
7139785MEDICAID (05)WA
G8869645MEDICARE PIN (08)WA

Map Location


PROVIDENCE HEALTH & SERVICE - WASHINGTON address is 2015 COOKS HILL RD SUITE 200 CENTRALIA, WA 98531