NPIMap

Organization Active NPI

Providence St. Peter Hospital

  • Clinical Medical Laboratory
  • Olympia, WA
National Provider Identifier
1497048615
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PROVIDENCE ST. PETER HOSPITAL
Practice address
413 Lilly Rd NE
Olympia, WA 98506-5133
Phone
(800) 752-8994
NPI assigned
May 20, 2011
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 Secreatry for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

413 Lilly Rd NE
Olympia, WA 98506-5133

Mailing address

PO Box 2670
Spokane, WA 99220-2670
Phone (800) 752-8994

Other names 1

  • Providence St. Peter Hospital PAC LAB Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2256234Providence St Peter Hospital Mobile Health Clinic413 Lilly Rd NE, Olympia, WA 98506Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Serv Wa10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

550 17th Ave
Ste 300
Seattle, WA 98122
Phone (206) 861-7000

NPI Registry JSON

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

{
    "created_epoch": "1305849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1497048615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2670",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992202670",
            "telephone_number": "800-752-8994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065133",
            "telephone_number": "800-752-8994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ST. PETER HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-20",
        "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 SECREATRY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence St. Peter Hospital PAC LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.