| NPI | 1316024128 |
|---|---|
| Doing Business As | PMG SOUTH MEDFORD PEDIATRICS |
| Doing Business As | PROVIDENCE MEDICAL GROUP SOUTH |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollment 425-358-9786 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-11-19 |