Provider Demographics
NPI:1265669451
Name:PROVIDENCE HEALTH & SERVICES - WA
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES - WA
Other - Org Name:PROVIDENCE MOBILE MAMMOGRAPHY COACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:509-474-3307
Mailing Address - Street 1:PO BOX 2555
Mailing Address - Street 2:WOMEN'S HEALTH CENTER
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-2555
Mailing Address - Country:US
Mailing Address - Phone:877-474-2400
Mailing Address - Fax:509-474-3129
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:WOMEN'S HEALTH CENTER
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:877-474-2400
Practice Address - Fax:509-474-3129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HEALTH & SERVICES - WA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-16
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile MammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA011004249Medicare Oscar/Certification