| NPI | 1346751443 | 
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP | 
| Entity Type | Organization | 
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollment 425-358-9786 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 208D00000X General Practice | 
| Enumeration Date | 2017-10-16 | 
| Last Update Date | 2025-07-04 |