# PROVIDENCE HEALTHCARE SERVICES

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

## Provider details

- **NPI number:** 1912101981
- **Authorized official:** MR. CLARK P. CHRISTIANSON (PRESIDENT)
- **Authorized official phone:** (251) 631-3574

## Contact information

- **Practice address:** 6901 AIRPORT BLVD, MOBILE, AL 36608-3795
- **Practice address phone:** (251) 639-5070
- **Practice address fax:** (251) 634-2994
- **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:** 06/13/2007
- **Last updated:** 08/27/2012