| NPI | 1376117325 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP - ORTHOPEDICS SOUTH |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Sec For Enrollment/Dir Reimb S 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2021-05-14 |