| Providence Medical Group | |
|
315 Se Stonemill Dr Ste 220 Vancouver WA 98684-6987 | |
| (360) 687-6650 | |
| Not Available |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 315 Se Stonemill Dr Ste 220, Vancouver, Washington |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY ENROLLMENTS) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group P.o.box 3158 Portland OR 97208-3158 Ph: (503) 215-7291 | Providence Medical Group 315 Se Stonemill Dr Ste 220 Vancouver WA 98684-6987 Ph: (360) 687-6650 |
| NPI Number | 1366748550 |
|---|---|
| Provider Enumeration Date | 02/04/2011 |
| Last Update Date | 10/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366748550 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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