Provider Demographics
NPI:1164724308
Name:PROVIDENCE HEALTH & SERVICES-WASHINGTON
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES-WASHINGTON
Other - Org Name:PROVIDENCE CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIZOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-413-8525
Mailing Address - Street 1:500 LILLY RD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5195
Mailing Address - Country:US
Mailing Address - Phone:360-413-8525
Mailing Address - Fax:360-413-8800
Practice Address - Street 1:500 LILLY RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5195
Practice Address - Country:US
Practice Address - Phone:360-413-8525
Practice Address - Fax:360-413-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-20
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty