NPIMap

Organization Active NPI

Alabama Providence Healthcare Services

  • General Practice Physician
  • Gulf Shores, AL
National Provider Identifier
1093174286
Registry record updated Feb 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
ALABAMA PROVIDENCE HEALTHCARE SERVICES
Practice address
1700 W 2ND St
Gulf Shores, AL 36542-3422
Phone
(251) 342-3949
Fax
(251) 631-3361
NPI assigned
Feb 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2016

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

Authorized official

Name
Todd Kennedy
Title
President
Phone
(251) 633-8880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1700 W 2ND St
Gulf Shores, AL 36542-3422

Mailing address

6701 Airport Blvd
Suite 143
Mobile, AL 36608-6705
Phone (251) 342-3949

Other identifiers 1

IdentifierTypeStateIssuer
156183MedicaidAL

Other names 1

  • Providence Medical Group - Gulf Shores Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Alabama Providence Healthcare Services27 organizations share this tax ID, including this one

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": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1093174286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 AIRPORT BLVD",
            "address_2": "SUITE 143",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086705",
            "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": "1700 W 2ND ST",
            "city": "GULF SHORES",
            "state": "AL",
            "postal_code": "365423422",
            "telephone_number": "251-342-3949",
            "fax_number": "251-631-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA PROVIDENCE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-16",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-633-8880"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156183",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medical Group - Gulf Shores",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gulf Shores, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.