| NPI | 1669765244 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP CAMAS |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollments 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 225100000X Physical Therapist |
| 261Q00000X Clinic/Center | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2024-09-30 |