NPIMap

Organization Active NPI

Providence Health & Services - Washington

  • Nephrology Physician
  • Walla Walla, WA
National Provider Identifier
1235373879
Registry record updated Mar 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
HAC.FS.00000050 Issued in WA
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Practice address
301 W Poplar St
Suite 100
Walla Walla, WA 99362-2858
Phone
(509) 522-5824
Fax
(509) 522-5738
NPI assigned
Apr 27, 2009
Last updated
Mar 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2026

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X HAC.FS.00000050 WA Primary

Addresses

Primary practice location

301 W Poplar St
Suite 100
Walla Walla, WA 99362-2858

Mailing address

PO Box 31001 - 4110
Pasadena, CA 91110-4110
Phone (509) 522-5906

Other names 1

  • Providence SMMC Nephrology DME Other name

National Provider Directory

National Provider Directory
Tax ID family
Providence HLTH Services-W17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772755200000",
    "number": "1235373879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4110",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104110",
            "telephone_number": "509-522-5906",
            "fax_number": "509-522-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W POPLAR ST",
            "address_2": "SUITE 100",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622858",
            "telephone_number": "509-522-5824",
            "fax_number": "509-522-5738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-27",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "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": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WA",
            "license": "HAC.FS.00000050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence SMMC Nephrology DME",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.