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) 633-1660
Entity
Organization
Contact information
Practice address
6701 AIRPORT BLVD, SUITE A101, MOBILE, AL 36608-6705
(251) 633-8880
(251) 633-2817
Mailing address
PO BOX 850489, MOBILE, AL 36685-0489
(251) 342-3964
(251) 631-3361
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RR0500X
Rheumatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529907120
—
AL
Enumeration date
06/13/2007
Last updated
09/13/2012
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