| NPI | 1013100262 |
|---|---|
| Doing Business As | PROV CENTRALIA INTERNAL MEDICINE |
| Entity Type | Organization |
| Authorized Contact | NICOLE QUINN Payor Credentialing Mananger 425-525-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RX0202X Internal Medicine, Medical Oncology |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2010-12-22 |