| Providence Physician Group | |
|
4112 Harbour Pointe Blvd Sw Suite 100 Mukilteo WA 98275-5457 | |
| (425) 347-6330 | |
| (425) 347-6335 |
| Full Name | Providence Physician Group |
|---|---|
| Speciality | Family Medicine |
| Location | 4112 Harbour Pointe Blvd Sw, Mukilteo, Washington |
| Authorized Official Name and Position | Barbara Schumacher (PRO FEE CREDENTIALING MANAGER) |
| Authorized Official Contact | 4253476330 |
| 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 4112 Harbour Pointe Blvd Sw Suite 100 Mukilteo WA 98275-5457 Ph: (425) 347-6330 |
| NPI Number | 1184654139 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 03/11/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184654139 | NPI | - | NPPES |
| 7126964 | Medicaid | WA |
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