| NPI | 1164623401 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Corp Sec For Enrollments 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2022-10-14 |