Providence Medical Group

LBN: Providence Healthcare Services
Providence Medical Group is an health care organization with primary practice located at 610 Providence Park Dr E Bldg. 1 Suite 102, Mobile AL 36695-4622. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as the primary health care specialty. Providence Healthcare Services can be contacted via phone (251) 378-3900, or through Christianson, Clark P. via phone (251) 631-3574.

Contact Information

Primary practice address
610 Providence Park Dr E Bldg. 1 Suite 102 Mobile AL 36695-4622
Phone: (251) 378-3900
Fax: (251) 378-3901
Website:
Map and Directions
Authorized official contact:
Name: Christianson, Clark P.
Phone: (251) 631-3574

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X

Profile Details

NPI number 1255535662
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 12th, 2007
Last updated Aug 27th, 2012 - about 13 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 1255535662 NPPES
Alabama MEDICAID 529907120

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