| NPI | 1841466141 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP GLISAN |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Asst Secretary Enrollment 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261Q00000X Clinic/Center | |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2024-06-13 |