Organization
ALABAMA PROVIDENCE HEALTHCARE SERVICES
Active
Other names
Providence Medical Group - Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
YESICA VIEYRA (CREDENTIALING SPECIALIST)
(205) 939-7633
Entity
Organization
Contact information
Practice address
6908 PROVIDENCE PARK DR S, MOBILE, AL 36695-4600
(251) 660-3490
(251) 660-3491
Mailing address
PO BOX 850489, MOBILE, AL 36685-0489
(251) 342-3949
(251) 631-3361
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156183
—
AL
Enumeration date
04/19/2017
Last updated
02/15/2019
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