# PROVIDENCE HEALTHCARE SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124222427
- **Authorized official:** MR. CLARK P. CHRISTIANSON (PRESIDENT)
- **Authorized official phone:** (251) 633-1660

## Contact information

- **Practice address:** 5100 RANGELINE ROAD NORTH, MOBILE, AL 36619-9504
- **Practice address phone:** (251) 661-4454
- **Practice address fax:** (251) 661-9843
- **Mailing address:** PO BOX 850489, MOBILE, AL 36685-0489
- **Mailing address phone:** (251) 342-3949
- **Mailing address fax:** (251) 631-3361

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/12/2007
- **Last updated:** 09/13/2012