Providence Medical Group

LBN: Providence Healthcare Services
Providence Medical Group is an health care organization with primary practice located at 29653 Anchor Cross Blvd , Daphne AL 36526-9594. 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
29653 Anchor Cross Blvd Daphne AL 36526-9594
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 1164683595
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 18th, 2008
Last updated Aug 27th, 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 1164683595 NPPES
Alabama MEDICAID 529907120

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