| Providence Physician Group | |
|
10200 Mukilteo Speedway Mukilteo WA 98275-4743 | |
| (425) 525-3194 | |
| Not Available |
| Full Name | Providence Physician Group |
|---|---|
| Speciality | General Practice |
| Location | 10200 Mukilteo Speedway, Mukilteo, Washington |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY - ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Physician Group Po Box 3360 Portland OR 97208-3360 Ph: () - | Providence Physician Group 10200 Mukilteo Speedway Mukilteo WA 98275-4743 Ph: (425) 525-3194 |
| NPI Number | 1306201488 |
|---|---|
| Provider Enumeration Date | 12/16/2015 |
| Last Update Date | 11/26/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306201488 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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