| NPI | 1194978064 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP NORTHEAST |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Sec For Enrollment/Dir Reimb S 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2023-09-29 |