| Providence Physician Group | |
|
12800 Bothell Everett Hwy Suite 180 Everett WA 98208-6642 | |
| (425) 316-5130 | |
| (425) 316-5131 |
| Full Name | Providence Physician Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 12800 Bothell Everett Hwy, Everett, Washington |
| Authorized Official Name and Position | Barbara Schumacher (PRO FEE CREDENTIALING MANAGER) |
| Authorized Official Contact | 4253165130 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Physician Group 909 N Broadway Pbo/credentialing Everett WA 98201-1409 Ph: (425) 317-0246 | Providence Physician Group 12800 Bothell Everett Hwy Suite 180 Everett WA 98208-6642 Ph: (425) 316-5130 |
| NPI Number | 1619050580 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 03/11/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619050580 | NPI | - | NPPES |
| 7095292 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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