NPI | 1710356001 |
---|---|
Doing Business As | PROVIDENCE MEDICAL GROUP SOUTH |
Entity Type | Organization |
Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollment 425-358-9786 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 261Q00000X Clinic/Center |
Enumeration Date | 2015-09-17 |
Last Update Date | 2025-05-12 |