NPI | 1093144180 |
---|---|
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 |
Enumeration Date | 2013-11-08 |
Last Update Date | 2015-09-28 |