Organization
PROVIDENCE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD S. KENNEDY (PRESIDENT AND CEO)
(251) 633-1663
Entity
Organization
Contact information
Practice address
6801 AIRPORT BLVD, MOBILE, AL 36608-3709
(251) 633-1600
(251) 633-1679
Mailing address
PO BOX 851537, MOBILE, AL 36685-1537
(251) 633-1600
(251) 633-1679
Taxonomy
Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
—
—
282N00000X
General Acute Care Hospital
Primary
10385
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00220487
—
MS
01
—
025
BLUE CROSS
—
01
—
10374
HEALTHSPRING
—
01
—
166828300
US DEPT OF LABOR
—
01
—
200020413
MS STATE PUBLIC SCHOOLS
—
01
—
5000060
MEDICARE COMPLETE
—
01
—
6120570
AETNA
—
05
—
H0S0090H
—
AL
Enumeration date
10/17/2005
Last updated
09/29/2015
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