| 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 |