PROVIDENCE HEALTH & SERVICES WASHINGTON - NPI 1952430902

Q: What is Providence Health & Services Washington's specialty?

The primary specialty registered for this NPI is Emergency Medicine, specializing in Emergency Medical Services, with taxonomy code 207PE0004X.

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About Providence Health & Services Washington NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI 1952430902), doing business as Providence Kodiak Island Medical Center, is a healthcare organization registered as an emergency medical services in Kodiak, Alaska and active in the NPI registry since March 2007. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1952430902

Entity TypeOrganization

Primary Taxonomy207PE0004X

Legal Business NamePROVIDENCE HEALTH & SERVICES WASHINGTON

Location Address1915 E REZANOF DRKodiak, AK 99615-6602

Mailing AddressPo Box 3706Portland, OR 97208-3706 · (907) 486-3281

Phone(907) 486-3281

Organization SubpartNo

Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786

Enumeration DateMarch 5, 2007

Last NPPES UpdateMay 13, 20252 updates tracked since enumeration

NPPES CertifiedMay 13, 2025

✔ NPI 1952430902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyEmergency Medicine · Emergency Medical ServicesAllopathic & Osteopathic Physicians

Taxonomy Code207PE0004X

Definition

An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients.

Also ListedHospitalistTaxonomy 208M00000X

Also ListedGeneral Acute Care Hospital · Critical AccessTaxonomy 282NC0060X · License 309115 (AK)

1915 E REZANOF DR, Kodiak, AK 99615

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Other Names 1

Doing Business AsProvidence Kodiak Island Medical Center

Other Identifiers 1

MedicaidMDG191AK

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PROVIDENCE HEALTH & SERVICES WASHINGTON

General Acute Care Hospital (Critical Access)