| NPI | 1184957821 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2024-07-19 |