| NPI | 1356763619 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Secretary For Enrollments 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2024-02-14 |