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 D430, MOBILE, AL 36608-6705
(251) 342-3949
(251) 631-3361
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
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
Other
Enumeration date
08/12/2006
Last updated
10/08/2012
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