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
610 PROVIDENCE PARK DR E, BLDG. 1 SUITE 102, MOBILE, AL 36695-4622
(251) 378-3900
(251) 378-3901
Mailing address
PO BOX 850489, MOBILE, AL 36685-0489
(251) 342-3949
(251) 631-3361
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529907120
—
AL
Enumeration date
06/12/2007
Last updated
08/27/2012
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