| NPI | 1104097906 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROV PEDS NEUROLOGY LONGVIEW |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Of Enrollments 425-358-9786 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2025-06-20 |