| NPI | 1194189654 |
|---|---|
| Doing Business As | PROVIDENCE FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary For Enrollment 425-525-5392 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2021-07-14 |