| NPI | 1760633879 |
|---|---|
| Doing Business As | PROVIDENCE PHYSICIAN GROUP - EVERETT NEURO |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Dir Reimb Reg Strat/Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2021-08-17 |