| NPI | 1871825018 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP MT |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Director Reimbursement Admin 425-525-5392 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2018-08-21 |