National Provider Identifier Database

PROVIDENCE HEALTH SERVICES WASHINGTON
Critical Access


Contact Information

PROVIDENCE HEALTH & SERVICES WASHINGTON
1915 E REZANOF DR
KODIAK, AK99615-6602
Phone: 907-486-9550
Fax:
Website:
Specialty Taxonomy Code
* Critical Access 282NC0060X
Long Term Care Pharmacy 3336L0003X

* Indicates primary specialty

NPI Profile & details for PROVIDENCE HEALTH & SERVICES WASHINGTON

NPI Number 1629054374
Legal business name
LBN
PROVIDENCE HEALTH & SERVICES WASHINGTON
Authorized official DONALD ANDERSON - (ASSISTANT SECRETARY OF ENROLLMENTS)
Entity Organization
Organization subpart No
Enumeration date 12/15/2005
Last updated 05/13/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • AK License #: 285

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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