| Pmg Providence Family Medicine South Grand | |
|
1919 S Grand Ave Pmg Providence Family Medicine South Grand Spokane WA 99204 | |
| (509) 252-0296 | |
| Not Available |
| Full Name | Pmg Providence Family Medicine South Grand |
|---|---|
| Speciality | Family Medicine |
| Location | 1919 S Grand Ave, Spokane, Washington |
| Authorized Official Name and Position | Michael Mallory (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4255256798 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pmg Providence Family Medicine South Grand P.o. Box 34439 Seattle WA 98124-1439 Ph: () - | Pmg Providence Family Medicine South Grand 1919 S Grand Ave Pmg Providence Family Medicine South Grand Spokane WA 99204 Ph: (509) 252-0296 |
| NPI Number | 1548552326 |
|---|---|
| Provider Enumeration Date | 05/11/2011 |
| Last Update Date | 05/11/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548552326 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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