| NPI | 1245669514 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | TODD S. KENNEDY President 251-633-1660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 207RR0500X Internal Medicine, Rheumatology | |
| 208D00000X General Practice | |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2015-09-28 |