NPIMap

Organization Active NPI

Providence Wa Anesthesia Services, P.C.

  • Anesthesiology Physician
  • Everett, WA
National Provider Identifier
1669615894
Registry record updated Oct 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
PROVIDENCE WA ANESTHESIA SERVICES, P.C.
Practice address
1321 Colby Ave
Everett, WA 98201-1665
Phone
(914) 491-9495
Fax
(800) 886-1042
NPI assigned
Apr 17, 2009
Last updated
Oct 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marc E. Koch, M.D.NPI 1629069497
Title
President & Ceo
Phone
(914) 491-9495

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

1321 Colby Ave
Everett, WA 98201-1665

Mailing address

450 Mamaroneck Ave Ste 201
Harrison, NY 10528-2436
Phone (914) 491-9495

Other identifiers 1

IdentifierTypeStateIssuer
7146251MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090513000135 WA Part B Supplier - Clinic/Group Practice 9335298884 Receives reassigned benefits from 173 practitioners
Practice locations: Anacortes, WA; Everett, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 217

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 217

NPI Registry JSON

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792108800000",
    "number": "1669615894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 MAMARONECK AVE STE 201",
            "city": "HARRISON",
            "state": "NY",
            "postal_code": "105282436",
            "telephone_number": "914-491-9495",
            "fax_number": "914-819-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 COLBY AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011665",
            "telephone_number": "914-491-9495",
            "fax_number": "800-886-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE WA ANESTHESIA SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-17",
        "last_updated": "2026-10-16",
        "certification_date": "2026-10-16",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "914-491-9495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7146251",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.