NPIMap

Organization Active NPI

Providence Health & Services - Wa

Doing business as PMG NW WA H P Urgent Care

  • General Practice Physician
  • Mukilteo, WA
National Provider Identifier
1003050709
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - WA
Doing business as
PMG NW WA H P Urgent Care
Practice address
4112 Harbour Pointe Blvd SW
Suite100
Mukilteo, WA 98275-5457
Phone
(425) 347-6350
Fax
(425) 347-6335
NPI assigned
Apr 24, 2009
Last updated
Jul 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

4112 Harbour Pointe Blvd SW
Suite100
Mukilteo, WA 98275-5457

Mailing address

PO Box 34439
Seattle, WA 98124-1439
Phone (425) 316-5469

Other names 1

  • PMG NW WA H P Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081224000111 WA Part B Supplier - Clinic/Group Practice 8325100480 Receives reassigned benefits from 816 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 34

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 34

National Provider Directory

National Provider Directory

Locations

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

44 Leigh St
Clinton, NJ 08809

180 Fort Washington Ave
#236
New York, NY 10032
Phone (212) 305-2330

12800 Bothell Everett Hwy
Ste 1
Everett, WA 98208

12800 Bothell Everett Hwy
Ste 100
Everett, WA 98208
Phone (425) 316-5090

12800 Bothell Everett Hwy
Ste 11
Everett, WA 98208

13110 Bothell Everett Hwy
#A
Everett, WA 98208

1321 Colby Ave
#A
Everett, WA 98201

1321 Colby Ave
Ste B400
Everett, WA 98201
Phone (425) 297-5234

1330 Rockefeller Ave
Ste 203
Everett, WA 98201

1330 Rockefeller Ave
Ste 520
Everett, WA 98201
Phone (425) 297-5200

1509 California St
Everett, WA 98201
Phone (425) 258-7900

2205 Broadway
#A
Everett, WA 98201

3216 Norton Ave
Ste 201
Everett, WA 98201
Phone (425) 258-4624

900 Pacific Ave
Ste 501
Everett, WA 98201
Phone (425) 258-7550

916 Pacific Ave
#7
Everett, WA 98201

12333 NE 130th Ln
Ste 130
Kirkland, WA 98034

2902 164th St SW
Lynnwood, WA 98087
Phone (425) 741-7750

11603 State Ave
Marysville, WA 98271

11630 State Ave Ste G
Marysville, WA 98271

1830 Bickford Ave
Snohomish, WA 98290
Phone (360) 568-1502

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753401600000",
    "number": "1003050709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34439",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241439",
            "telephone_number": "425-316-5469",
            "fax_number": "425-316-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 HARBOUR POINTE BLVD SW",
            "address_2": "SUITE100",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982755457",
            "telephone_number": "425-347-6350",
            "fax_number": "425-347-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-24",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMG NW WA H P Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mukilteo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.