| NPI | 1497959613 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | TODD KENNEDY President 251-631-3574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2017-05-09 |