NPIMap

Organization Active NPI

Alabama Providence Healthcare Services

Doing business as Providence Medical Group

  • Internal Medicine Physician
  • Mobile, AL
National Provider Identifier
1043649148
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ALABAMA PROVIDENCE HEALTHCARE SERVICES
Doing business as
Providence Medical Group
Practice address
6701 Airport Blvd
Suite A101
Mobile, AL 36608-6705
Phone
(251) 633-8880
Fax
(251) 633-2817
NPI assigned
Nov 8, 2013
Last updated
Sep 28, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
ALABAMA PROVIDENCE HEALTHCARE SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Todd S. Kennedy
Title
President
Phone
(251) 633-1660

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU
Gastroenterology Physician 207RG0100X NU
Rheumatology Physician 207RR0500X NU

Addresses

Primary practice location

6701 Airport Blvd
Suite A101
Mobile, AL 36608-6705

Mailing address

PO Box 850489
Mobile, AL 36685-0489
Phone (251) 342-3949

Other names 1

  • Providence Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Al Prov Hlthcr SRVS27 organizations share this tax ID, including this one
Part of
Al Prov Hlthcr SRVS

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1043649148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850489",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366850489",
            "telephone_number": "251-342-3949",
            "fax_number": "251-631-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 AIRPORT BLVD",
            "address_2": "SUITE A101",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086705",
            "telephone_number": "251-633-8880",
            "fax_number": "251-633-2817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA PROVIDENCE HEALTHCARE SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALABAMA PROVIDENCE HEALTHCARE SERVICES",
        "enumeration_date": "2013-11-08",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-633-1660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.