NPIMap

Organization Active NPI

Providence Health & Services Washington

  • Clinical Medical Laboratory
  • Centralia, WA
National Provider Identifier
1548480866
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PROVIDENCE HEALTH & SERVICES WASHINGTON
Practice address
914 S Scheuber Rd
Centralia, WA 98531-9027
Phone
(360) 736-2803
NPI assigned
Apr 27, 2007
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
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

914 S Scheuber Rd
Centralia, WA 98531-9027

Mailing address

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

Other names 1

  • Providence Centralia Lab Former legal business name

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
50D0637130Providence Centralia Hospital914 South Scheuber Road, Centralia, WA 98531AccreditationApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Service-4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

916 Pacific Ave
Rm 120
Everett, WA 98201

1330 Rockefeller Ave
Ste 110
Everett, WA 98201

NPI Registry JSON

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1548480866",
    "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": "914 S SCHEUBER RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319027",
            "telephone_number": "360-736-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-27",
        "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": "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 Centralia Lab",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 5, 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.