Providence Physician Group | |
14692 179th Ave Se Suite 100 Monroe WA 98272-1198 | |
(360) 794-7994 | |
(360) 805-4755 |
Full Name | Providence Physician Group |
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Speciality | Family Medicine |
Location | 14692 179th Ave Se, Monroe, Washington |
Authorized Official Name and Position | Earl D. Beegle (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 4253165470 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Providence Physician Group 909 N Broadway Everett WA 98201-1409 Ph: (425) 317-0257 | Providence Physician Group 14692 179th Ave Se Suite 100 Monroe WA 98272-1198 Ph: (360) 794-7994 |
NPI Number | 1518040484 |
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Provider Enumeration Date | 10/23/2006 |
Last Update Date | 11/21/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518040484 | NPI | - | NPPES |
7096183 | Medicaid | WA |
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