| Organization Name: | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| NPI Number: | 1144536269 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDEE REID (CREDENTIALING COORD) |
| Mailing Address: | 107 Sw 1st St Suite 104 Enterprise |
| State: | OR US |
| Postal Code: | 97828 |
| Phone Number: | 5098387711 |
| Fax Number: | |
| NPI Enumeration Date: | 08/26/2010 |
| NPI Last Update Date: | 08/26/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |