| NPI | 1780099242 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | TODD S. KENNEDY President 251-633-1660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2015-09-28 |