Providence Physician Group
LBN: Providence Physician Group
Providence Physician Group is an health care organization with primary practice located at 12800 Bothell Everett Hwy Suite 120, Everett WA 98208-6642. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Clinic/Center, Suppliers / Durable Medical Equipment & Medical Supplies. Suppliers / Durable Medical Equipment & Medical Supplies is the primary health care specialty.
Providence Physician Group can be contacted via phone (425) 316-5150, or through Beegle, Earl D. via phone (425) 316-5470.
Contact Information
Primary practice address
12800 Bothell Everett Hwy Suite 120
Everett WA 98208-6642
Phone: (425) 316-5150
Fax: (425) 316-5153
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Clinic/Center | 261Q00000X | ||
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X |
Profile Details
| NPI number | 1639258130 |
|---|---|
| LBN Legal business name | Providence Physician Group |
| DBA Doing business as | |
| Authorized official | Beegle, Earl D. Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 3rd, 2006 |
| Last updated | Nov 21st, 2007 - about 17 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639258130 | NPPES |
| Washington | MEDICAID | 7095367 |
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