NPIMap

Organization Active NPI

Providence Health & Services - Washington

Doing business as Providence Physician Group Dexascan PHCC

  • Bone Densitometry Radiologic Technologist
  • Everett, WA
National Provider Identifier
1275785669
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Bone Densitometry Radiologic TechnologistTaxonomy code 2471B0102X
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Doing business as
Providence Physician Group Dexascan PHCC
Practice address
12800 Bothell Everett Hwy
Suite 260B
Everett, WA 98208-6642
Phone
(425) 316-5425
Fax
(425) 316-5427
NPI assigned
Oct 16, 2008
Last updated
Jul 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085B0100X
Bone Densitometry Radiologic TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 2471B0102X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

12800 Bothell Everett Hwy
Suite 260B
Everett, WA 98208-6642

Mailing address

909 N Broadway
Pbo/Credentialing
Everett, WA 98201-1409
Phone (425) 317-0246

Other names 1

  • Providence Physician Group Dexascan PHCC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
PMG NW Wa Cardiology13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

12800 Bothell Everett Hwy
Ste 260B
Everett, WA 98208
Phone (425) 316-5080

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1275785669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 N BROADWAY",
            "address_2": "PBO/CREDENTIALING",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011409",
            "telephone_number": "425-317-0246",
            "fax_number": "425-317-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 BOTHELL EVERETT HWY",
            "address_2": "SUITE 260B",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086642",
            "telephone_number": "425-316-5425",
            "fax_number": "425-316-5427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "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": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471B0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Bone Densitometry",
            "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": "Providence Physician Group Dexascan PHCC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; 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.