| NPI | 1356683213 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER DOAN Managing Associate General Counsel 310-259-4706 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| 207L00000X Anesthesiology | |
| 207LP2900X Anesthesiology, Pain Medicine | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 207VF0040X Obstetrics & Gynecology, Female Pelvic Medicine and Reconstructive Surgery | |
| 207X00000X Orthopaedic Surgery | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 208600000X Surgery | |
| 2086S0120X Surgery, Pediatric Surgery | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2023-08-01 |