| NPI | 1841452521 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PMG BRIDGEPORT |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Dir Reimb Reg Strat/Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2024-09-29 |