| NPI | 1043366172 |
|---|---|
| Doing Business As | PROVIDENCE CONNECTIONS MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Asst Sec For Enroll/Dir Reimb Admin 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2023-11-21 |