NPIMap

Organization Active NPI

Providence Health & Services - Washington

  • Mammography Clinic/Center
  • Centralia, WA
National Provider Identifier
1528267804
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
License
602399531 Issued in WA
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Practice address
908 S Scheuber Rd
Centralia, WA 98531-9027
Phone
(360) 330-8880
NPI assigned
Jul 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 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 Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mammography Clinic/Center 261QR0206X 602399531 WA Primary

Addresses

Primary practice location

908 S Scheuber Rd
Centralia, WA 98531-9027

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7124043MedicaidWA

Other names 1

  • Providence Imaging Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Providence Anesthesia Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

909 N Broadway
Everett, WA 98201
Phone (425) 317-0699

NPI Registry JSON

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1528267804",
    "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": "908 S SCHEUBER RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319027",
            "telephone_number": "360-330-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "WA",
            "license": "602399531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7124043",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centralia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.