| NPI | 1922259738 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP SOUTHEAST WASHINGTON |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Sec Of Enrollment/Dir Reimb St 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA H-050) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 207R00000X Internal Medicine (Licence: WA H-050) | |
| 207X00000X Orthopaedic Surgery (Licence: WA H-050) | |
| 208600000X Surgery (Licence: WA H-050) | |
| 225000000X Orthotic Fitter | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2022-09-02 |