| NPI | 1144471533 |
|---|---|
| Other Name | PROVIDENCE PHYSICIAN GROUP - CRANIAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | NICHOLE QUINN Payor Credentialing Manager 425-525-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Enumeration Date | 2008-10-04 |
| Last Update Date | 2010-12-27 |