| NPI | 1316125149 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Sec For Enrollment/A VP Reimbur 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2024-05-22 |