Providence Physician Services Co

NPI #1184915829 in Seattle, Washington

Provider Information

NPI Number: 1184915829
Entity Type: Organization
Organization Name: Providence Physician Services Co
Subpart: Yes (part of a larger organization)
Parent Organization: PROVIDENCE PHYSICIAN SERVICES CO
Primary Specialty: Family Medicine
Enumeration Date: Apr 28, 2011
Last Updated: Apr 28, 2011

Practice Location

Address: 5011 W. LOWELL AVE
City: Seattle
State: Washington
ZIP Code: 99208-8587
Phone: (509) 484-8069

Authorized Official

Name: MR. MICHAEL J MALLORY
Title: CREDENTIALING SPECIALIST
Phone: (425) 525-6798

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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