| Providence Physician Group | |
|
14692 179th Ave Se Suite 100 Monroe WA 98272-1198 | |
| (360) 794-7994 | |
| (360) 805-4755 |
| Full Name | Providence Physician Group |
|---|---|
| Speciality | Family Medicine |
| Location | 14692 179th Ave Se, Monroe, Washington |
| Authorized Official Name and Position | Earl D. Beegle (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4253165470 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Physician Group 909 N Broadway Everett WA 98201-1409 Ph: (425) 317-0257 | Providence Physician Group 14692 179th Ave Se Suite 100 Monroe WA 98272-1198 Ph: (360) 794-7994 |
| NPI Number | 1518040484 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 11/21/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518040484 | NPI | - | NPPES |
| 7096183 | Medicaid | WA |
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