| NPI | 1215431697 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP SW WA - MDPP |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Corp Secretary Enrollment 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2018-03-21 |