| NPI | 1881191948 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP MT - MDPP |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollments 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 133VN1006X Dietitian, Registered, Nutrition, Metabolic |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2025-05-07 |