| NPI | 1013086875 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP MILWAUKIE |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Dir Reimb Reg Strat/Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-07-15 |