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
253 PROFESSIONAL LN, GULF SHORES, AL 36542-3461
(251) 631-3490
(251) 631-3461
Mailing address
PO BOX 850489, MOBILE, AL 36685-0489
(251) 342-3949
(251) 631-3361
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
940365
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529907120
—
AL
Enumeration date
05/12/2011
Last updated
08/27/2012
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