| Providence Medical Group Sw Wa - Mdpp | |
|
4800 College St Se Lacey WA 98503-4389 | |
| (360) 493-7567 | |
| (360) 412-6468 |
| Full Name | Providence Medical Group Sw Wa - Mdpp |
|---|---|
| Speciality | Clinic/Center |
| Location | 4800 College St Se, Lacey, Washington |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST CORP SECRETARY - ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Sw Wa - Mdpp 4800 College St Se Lacey WA 98503-4389 Ph: (360) 493-7567 | Providence Medical Group Sw Wa - Mdpp 4800 College St Se Lacey WA 98503-4389 Ph: (360) 493-7567 |
| NPI Number | 1215431697 |
|---|---|
| Provider Enumeration Date | 03/21/2018 |
| Last Update Date | 03/21/2018 |
| Medicare PECOS PAC ID | 6709782600 |
|---|---|
| Medicare Enrollment ID | O20180606000285 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215431697 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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