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Organization
PROVIDENCE HEALTHCARE SERVICES
Active
Organization
PROVIDENCE HEALTHCARE SERVICES
Active
Other names
Providence Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARK P. CHRISTIANSON (PRESIDENT)
(251) 631-3574
Entity
Organization
Contact information
Practice address
18317 US HWY 90, ROBERTSDALE, AL 36567
(251) 947-2000
(251) 947-5399
Mailing address
PO BOX 850489, MOBILE, AL 36685-0489
(251) 342-3949
(251) 631-3361
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
AL
207R00000X
Internal Medicine Physician
—
AL
Other
Enumeration date
03/27/2007
Last updated
08/27/2012
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