Provider Demographics
NPI:1598065419
Name:PROVIDENCE HEALTH AND SERVICES
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIGAYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-525-6717
Mailing Address - Street 1:PO BOX 34439
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1439
Mailing Address - Country:US
Mailing Address - Phone:425-525-6717
Mailing Address - Fax:
Practice Address - Street 1:2001 LIND AVENUE SW
Practice Address - Street 2:SUITE 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98124-1439
Practice Address - Country:US
Practice Address - Phone:425-525-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization