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PROVIDENCE HEALTHCARE SERVICES NPI 1255535662


NPI Information

NPI: 1255535662
Provider Name: PROVIDENCE HEALTHCARE SERVICES

Doing Business As: PROVIDENCE MEDICAL GROUP

Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Address:
610 PROVIDENCE PARK DR E
BLDG. 1 SUITE 102
MOBILE, AL
ZIP 36695
Phone: (251) 378-3900
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PROVIDENCE HEALTHCARE SERVICES is an internal medicine in Mobile, AL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. PROVIDENCE HEALTHCARE SERVICES NPI is 1255535662. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Providence Medical Group.

The provider's business location address is:

610 PROVIDENCE PARK DR E
BLDG. 1 SUITE 102
MOBILE, AL
ZIP 36695-622
Phone: (251) 378-3900
Fax: (251) 378-3901

The provider's authorized official is Clark P. Christianson .
The authorized official title is President and has the following contact phone number (251) 631-3574.

The enumeration date for this NPI number is 6/12/2007 and was last updated on 8/27/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1H968MEDICARE PINALABAMA
2529907120MEDICAIDALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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