| NPI | 1033535463 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Other Name | PROVIDENCE PEDIATRIC NEUROLOGY CHILD CENTER |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Of Enrollment 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2024-01-18 |