| NPI | 1235479643 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP SPORTS CARE |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secreatry For Enrollment 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RS0010X Internal Medicine, Sports Medicine | |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2025-05-16 |