| Providence Medical Group Battle Ground Family Medicine | |
|
101 Nw 12th Ave Suite 107 Battle Ground WA 98604-9141 | |
| (360) 666-4480 | |
| (360) 666-4485 |
| Full Name | Providence Medical Group Battle Ground Family Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 101 Nw 12th Ave, Battle Ground, Washington |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Battle Ground Family Medicine Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Medical Group Battle Ground Family Medicine 101 Nw 12th Ave Suite 107 Battle Ground WA 98604-9141 Ph: (360) 666-4480 |
| NPI Number | 1194013144 |
|---|---|
| Provider Enumeration Date | 07/12/2011 |
| Last Update Date | 12/07/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194013144 | NPI | - | NPPES |
| 500639583 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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