Providence Health & Services Washington

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PROVIDENCE HEALTH & SERVICES WASHINGTON

Doing business as

Providence Medical Group Lab- Physicians Clinic

Practice address

820 S McClellan St Ste LL10
Spokane, WA 99204-2446

Phone

(509) 353-4260

NPI assigned

Dec 7, 2012

Last updated

May 5, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald W. Anderson Jr.

Title

Assistant Secretary of Enrollments

Phone

(425) 358-9786

Specialties & licenses 1

Addresses

Other names 1

• Providence Medical Group Lab- Physicians Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Providence Health & Services Washington

  dba Providence Medical Group

  • Pulmonary Disease Physician
  • Spokane, WA
  • NPI 1194099390

  0345139929

  Same PAC ID
• Providence Health & Services Washington

  dba Providence NEWMG Colville

  • Rural Health Clinic/Center
  • Colville, WA
  • NPI 1255685822

  0345139929

  Same PAC ID
• Providence Health & Services Washington

  dba Providence Medical Group - Orthopedics South

  • Orthopaedic Surgery Physician
  • Spokane, WA
  • NPI 1376117325

  0345139929

  Same PAC ID
• Providence Health & Services Washington

  dba Providence Northeast Washington Medical Group - Kettle Falls

  • Rural Health Clinic/Center
  • Kettle Falls, WA
  • NPI 1538413109

  0345139929

  Same PAC ID
• Providence Health & Services Washington

  dba Providence Family Medicine Chewelah

  • Rural Health Clinic/Center
  • Chewelah, WA
  • NPI 1639892672

  0345139929

  Same PAC ID
• Providence Health & Services Washington

  dba PMG E Wa PMP Orthopedics DME

  • Orthopaedic Surgery Physician
  • Spokane Valley, WA
  • NPI 1710386818

  0345139929

  Same PAC ID
• Providence Health & Services Washington

  • Orthopaedic Surgery Physician
  • Spokane, WA
  • NPI 1881059954

  0345139929

  Same PAC ID

Locations (25 of 26)

Practitioners 7

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.

• Sumant Arora, M.D.

  • Gastroenterology Physician
  • Spokane, WA
  • NPI 1134535560
  NPD (past)
• Holly Eckhart, ARNP, FNP-BC

  • Family Nurse Practitioner
  • Spokane, WA
  • NPI 1275042491
  NPD (past)
• Debra Johnson Fuller, ARNP

  • Family Nurse Practitioner
  • Spokane, WA
  • NPI 1093095663
  NPD (past)
• Kathleen M Manion, ARNP

  • Family Nurse Practitioner
  • Spokane, WA
  • NPI 1376613422
  NPD (past)
• Kathleen Marie Schatz, ARNP

  • Family Nurse Practitioner
  • Spokane, WA
  • NPI 1912100496
  NPD (past)
• April Jean Walter, AG-ACNP

  • Acute Care Nurse Practitioner
  • Spokane, WA
  • NPI 1164072567
  NPD (past)
• Caron M Cook, P.A,

  • Physician Assistant
  • Rockford, IL
  • NPI 1003951799
  NPD (past)

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

{
    "created_epoch": "1354838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1902141500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S MCCLELLAN ST STE LL10",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042446",
            "telephone_number": "509-353-4260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-07",
        "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": "W.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "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 Medical Group Lab- Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group Lab- Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Health & Services Washington (Providence Medical Group)
• Providence Health & Services Washington (PMG PHC Providence Express Care)
• Providence Health & Services Washington (Providence Medical Group - Orthopedics South)
• Providence Health & Services Washington
• Providence Health & Services Washington (Providence Spokane Heart Institute)
• Providence Health & Services- Washington (Providence St Lukes Rehabilitation Medical Center)
• Providence Health & Services- Washington (Providence St Lukes Rehabilitation Medical Center)
• Providence Health & Services-Wa (NW Heart & Lung Surgical Assoc)
• Providence Health & Services-Washington (Sacred Heart Maternity Support Services)
• Providence Physician Services Co (PPS Prov Family Med Northpoint)

• Clinical Medical Laboratory in Spokane, WA
• Providers in Spokane, WA by specialty
• Clinical Medical Laboratory in Washington

• 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 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.