| NPI | 1245567817 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP CANBY IMMEDIATE CARE |
| 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 |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2021-04-16 |