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
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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