| Providence Physician Group | |
|
14692 179th Ave Se Suite 500 Monroe WA 98272-1198 | |
| (360) 794-7994 | |
| (360) 805-4757 |
| Full Name | Providence Physician Group |
|---|---|
| Speciality | Clinic/center |
| Location | 14692 179th Ave Se, Monroe, Washington |
| Authorized Official Name and Position | Barbara Schumacher (PRO FEE CREDENTIALING MANAGER) |
| Authorized Official Contact | 3607947994 |
| 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 14692 179th Ave Se Suite 500 Monroe WA 98272-1198 Ph: (360) 794-7994 |
| NPI Number | 1699701987 |
|---|---|
| Provider Enumeration Date | 06/25/2006 |
| Last Update Date | 03/11/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699701987 | NPI | - | NPPES |
| 7096183 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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