NPIMap

Organization Active NPI

Providence Health & Services Washington

Doing business as Providence North East Washington Medical Group

  • Family Medicine Physician
  • Colville, WA
National Provider Identifier
1083968879
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROVIDENCE HEALTH & SERVICES WASHINGTON
Doing business as
Providence North East Washington Medical Group
Practice address
1200 E Columbia Ave
Colville, WA 99114-3354
Phone
(509) 474-2072
NPI assigned
Nov 1, 2012
Last updated
May 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1200 E Columbia Ave
Colville, WA 99114-3354

Mailing address

PO Box 31001-4114
Pasadena, CA 91110-4114

Other practice location 1

143 Garden Homes Dr
Colville, WA 99114-9229
Phone (509) 684-3701

Other practice location 2

100 W South Ave
Chewelah, WA 99109-9684
Phone (509) 684-3701

Other names 1

  • Providence North East Washington Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311001453 WA Part B Supplier - Clinic/Group Practice 0345139929 Receives reassigned benefits from 946 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20151222000687 MT Part B Supplier - Clinic/Group Practice 0345139929 Receives reassigned benefits from 7 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somers, MT; Missoula, MT; Lolo, MT

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

23813 E Appleway Ave
Liberty Lake, WA 99019
Phone (509) 928-6383

101 W 8th Ave
Ste 4200E
Spokane, WA 99204
Phone (509) 474-5440

105 W 8th Ave
Ste 318C
Spokane, WA 99204
Phone (509) 474-6650

2020 E 29th Ave
Lowr
Spokane, WA 99203
Phone (509) 626-9400

217 W Cataldo Ave
Fl 3
Spokane, WA 99201
Phone (509) 624-2326

546 N Jefferson Ln
Ste 100
Spokane, WA 99201
Phone (509) 624-0111

8925 N Indian Trail Rd
Spokane, WA 99208
Phone (509) 352-7543

920 N Washington St
Spokane, WA 99201
Phone (509) 252-4200

9911 N Nevada St
Ste 200
Spokane, WA 99218
Phone (509) 626-9420

9922 N Nevada St
Spokane, WA 99218
Phone (509) 624-2326

16528 E Desmet Ct
Ste A2200
Spokane Valley, WA 99216
Phone (509) 489-2600

Practitioners & affiliated clinicians

Practitioners 290

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 290

NPI Registry JSON

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

{
    "created_epoch": "1351728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1083968879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E COLUMBIA AVE",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991143354",
            "telephone_number": "509-474-2072"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "143 Garden Homes Dr",
            "address_purpose": "LOCATION",
            "city": "Colville",
            "state": "WA",
            "postal_code": "991149229",
            "country_code": "US",
            "telephone_number": "509-684-3701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 W South Ave",
            "address_purpose": "LOCATION",
            "city": "Chewelah",
            "state": "WA",
            "postal_code": "991099684",
            "country_code": "US",
            "telephone_number": "509-684-3701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-01",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence North East Washington Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence North East Washington Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.