NPI | 1033299458 |
---|---|
Doing Business As | PROVIDENCE PEDS SPEC MJP |
Entity Type | Organization |
Authorized Contact | DONALD W ANDERSON Dir Reimb Reg Strat/Asst Sec Enroll 425-525-5392 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center |
Enumeration Date | 2006-10-17 |
Last Update Date | 2021-11-04 |