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Providence Health & Services Washington
Clinic/Center in Lacey, Washington
NPI 1063611408

Providence Health & Services Washington is a Clinic/Center based in Portland, WA. Providence Health & Services Washington practices in Lacey, WA. The NPI Number for Providence Health & Services Washington is 1063611408 and holds a License No. H-159 (Washington).

The current practice location address for Providence Health & Services Washington is 420 Golf Club Rd Se, Lacey, WA and can be reached out via phone at 360-493-7469 and via fax at 360-459-2023.

Location: 420 Golf Club Rd Se, Lacey, WA, 97208-3505
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1063611408
Provider Name
Providence Health & Services Washington
Credential
Provider Entity Type
Organization
Address
420 Golf Club Rd Se, Lacey, WA, 97208-3505
Phone Number
360-493-7469
Fax Number
360-459-2023
Provider Enumeration Date
07/16/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
8919875 01 WA L&I CRIME VICTIMS
129210 01 WA L&I
7115611 05 WA
institution
Provider Business Practice Location Address Details
Address
420 Golf Club Rd Se
City
Lacey
State
Washington
Zip
98503-1048
Phone Number
360-493-7469
Fax Number
360-459-2023
person
Provider Business Mailing Address Details
Address
420 Golf Club Rd Se
City
Lacey
State
Washington
Zip
98503-1048
Phone Number
360-493-7469
Fax Number
360-459-2023
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
H-159 (Washington)
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
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