PROVIDENCE PHYSICIAN GROUP

EVERETT, WA
NPI1093896854
Entity TypeOrganization
Authorized ContactBARBARA SCHUMACHER
Pro Fee Credentialing Manager
425-316-5180
Organization Subpart ?No
Primary Taxonomy207Q00000X Family Medicine
Additional Taxonomies2471B0102X Radiologic Technologist, Bone Densitometry
332B00000X Durable Medical Equipment & Medical Supplies
Enumeration Date2006-10-18
Last Update Date2010-03-11
Business Address
PROVIDENCE PHYSICIAN GROUP
12800 BOTHELL EVERETT HWY SUITE 160
EVERETT, WA 98208-6644
Phone number: 425-316-5180
Mailing Address
PROVIDENCE PHYSICIAN GROUP
909 N BROADWAY PBO/CREDENTIALING
EVERETT, WA 98201-1409
Phone number: 425-317-0246