| NPI | 1639279706 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP TANASBOURNE |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Asst Sec Enroll 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-06-30 |