| NPI | 1124129903 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP GATEWAY FAMILY & COMMUNITY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Asst Sec Enrollment/EVP Reimb 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2024-06-10 |