| NPI | 1033299458 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE PEDS SPEC MJP |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Assistant Secretary Of Enrollments 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2025-06-20 |