NPI | 1790881498 |
---|---|
Doing Business As | PROVIDENCE MEDICAL GROUP |
Doing Business As | PROVIDENCE MEDICAL GROUP GATEWAY |
Entity Type | Organization |
Authorized Contact | DONALD W ANDERSON Assistant Secretary For Enrollment 425-358-9786 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 261Q00000X Clinic/Center |
Enumeration Date | 2006-09-16 |
Last Update Date | 2025-07-04 |