Providence Medical Group

LBN: Providence Healthcare Services
Providence Medical Group is an health care organization with primary practice located at 6701 Airport Blvd Suite B127, Mobile AL 36608-6705. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Gynecologic Oncology, which is considered as the primary health care specialty. Providence Healthcare Services can be contacted via phone (251) 631-3490, or through Christianson, Clark P. via phone (251) 631-3574.

Contact Information

Primary practice address
6701 Airport Blvd Suite B127 Mobile AL 36608-6705
Phone: (251) 631-3490
Fax: (251) 631-3461
Website:
Map and Directions
Authorized official contact:
Name: Christianson, Clark P.
Phone: (251) 631-3574

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecologic Oncology 207VX0201X

Profile Details

NPI number 1013113760
LBN Legal business name Providence Healthcare Services
DBA Doing business as Providence Medical Group
Authorized official Christianson, Clark P.
Entity Organization
Organization subpart 1 No
Enumeration date Jun 21st, 2007
Last updated Sep 17th, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013113760 NPPES
Alabama MEDICAID 529907120

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