PROVIDENCE PHYSICIAN GROUP

EVERETT, WA
NPI1225119050
Entity TypeOrganization
Authorized ContactBARBARA SCHUMACHER
Pro Fee Credentialing Manager
425-258-7050
Organization Subpart ?No
Primary Taxonomy207Q00000X Family Medicine
Additional Taxonomies207R00000X Internal Medicine
208000000X Pediatrics
332B00000X Durable Medical Equipment & Medical Supplies
Enumeration Date2006-10-18
Last Update Date2010-03-11
Business Address
PROVIDENCE PHYSICIAN GROUP
5007 CLAREMONT WAY
EVERETT, WA 98203-3321
Phone number: 425-258-7050
Mailing Address
PROVIDENCE PHYSICIAN GROUP
909 N BROADWAY PBO/CREDENTIALING
EVERETT, WA 98201-1409
Phone number: 425-317-0246