PROVIDENCE PHYSICIAN GROUP

EVERETT, WA
NPI1619050580
Entity TypeOrganization
Authorized ContactBARBARA SCHUMACHER
Pro Fee Credentialing Manager
425-316-5130
Organization Subpart ?No
Primary Taxonomy207R00000X Internal Medicine
Additional Taxonomies332B00000X Durable Medical Equipment & Medical Supplies
Enumeration Date2006-10-23
Last Update Date2010-03-11
Business Address
PROVIDENCE PHYSICIAN GROUP
12800 BOTHELL EVERETT HWY SUITE 180
EVERETT, WA 98208-6642
Phone number: 425-316-5130
Mailing Address
PROVIDENCE PHYSICIAN GROUP
909 N BROADWAY PBO/CREDENTIALING
EVERETT, WA 98201-1409
Phone number: 425-317-0246