| NPI | 1134656135 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP SOUTHWEST WASHINGTON |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Asst Sec For Enrollment / Dir Reimb 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2017-11-26 |