| NPI | 1700987401 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP TANASBOURNE IMMEDIATE CARE |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Corp Secretary For Enrollments 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2018-07-09 |