| NPI | 1346751443 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Reimbursement Administration Direct 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-16 |