Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Providence Health & Services Washington

Organization Diagnostic Radiology Physician · NPI 1003367863

Providence Health & Services Washington provides Diagnostic Radiology Physician services in Lacey, Washington. Registered with an NPI since 2016.

In the registry since
2016

Practice location Address checks out

4800 College St SE Ste E
Lacey, WA 98503-4389
Phone: (360) 489-2960
Fax: (360) 489-2961
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X

Record details

NPI number1003367863
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secretary For Enrollment · (425) 358-9786
Other names Providence St Peter Hospital Diagnostic Imaging Lacey
NPI enumeratedOctober 17, 2016
Last updated in NPPESMay 13, 2025
Certification dateMay 13, 2025
Mailing addressPo Box 31001-4110, Pasadena, CA 91110-4110

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