| NPI | 1083043822 |
|---|---|
| Other Name | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | TODD S. KENNEDY President 251-633-1660 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2015-09-28 |