| NPI | 1679826317 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE THORACIC SURGERY WEST |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secreatry For Enrollment 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2025-06-30 |