| Pmg Providence Family Medicine Chewelah | |
|
100 W. South Ave Chewelah Chewelah WA 99109 | |
| (509) 935-8111 | |
| Not Available |
| Full Name | Pmg Providence Family Medicine Chewelah |
|---|---|
| Speciality | Family Medicine |
| Location | 100 W. South Ave Chewelah, Chewelah, Washington |
| Authorized Official Name and Position | Michael J Mallory (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6175041926 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pmg Providence Family Medicine Chewelah Po Box 34439 Seattle WA 98124 Ph: () - | Pmg Providence Family Medicine Chewelah 100 W. South Ave Chewelah Chewelah WA 99109 Ph: (509) 935-8111 |
| NPI Number | 1619268281 |
|---|---|
| Provider Enumeration Date | 04/29/2011 |
| Last Update Date | 04/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619268281 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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