| NPI | 1538400114 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP MATERNAL CARE CLINIC |
| Entity Type | Organization |
| Authorized Contact | KEENAN B FREEM CFO 503-893-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| 367A00000X Advanced Practice Midwife | |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2013-11-21 |