| NPI | 1124458914 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Dir Reimb Reg Strat/Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2023-03-02 |