| NPI | 1750482451 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP SOUTHWEST PEDIATRIC CLINIC |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON A VP/ Ass Secretary Enrollment 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2024-05-28 |