| NPI | 1831499755 |
|---|---|
| Doing Business As | PROVIDENCE PHYSICIAN GROUP- NEUROSURGERY AND SPINE CLINIC |
| Entity Type | Organization |
| Authorized Contact | NICHOLE QUINN Payor Credentialing Manager 425-525-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2010-12-27 |