Providence Physician Services Co
NPI #1619268281 in Chewelah, Washington
Provider Information
- NPI Number
- 1619268281
- 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 29, 2011
- Last Updated
- Apr 29, 2011
Practice Location
- Address
- 100 W. SOUTH AVE CHEWELAH
- City
- Chewelah
- State
- Washington
- ZIP Code
- 99109
- Phone
- (509) 935-8111
Authorized Official
- Name
- MR. MICHAEL J MALLORY
- Title
- CREDENTIALING SPECIALIST
- Phone
- (617) 504-1926
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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