Providence Healthcare Services

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDENCE HEALTHCARE SERVICES

Practice address

18317 US Hwy 90
Robertsdale, AL 36567

Phone

(251) 947-2000

Fax

(251) 947-5399

NPI assigned

Mar 27, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Clark P. Christianson

Title

President

Phone

(251) 631-3574

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Providence Medical Group Doing business as

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1184742363",
    "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": "18317 US HWY 90",
            "city": "ROBERTSDALE",
            "state": "AL",
            "postal_code": "36567",
            "telephone_number": "251-947-2000",
            "fax_number": "251-947-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "CHRISTIANSON",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-631-3574",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529907120",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrew Marco Pischek
• Roberto V Pischek, D.M.D.
• Jennifer Shea Sanders Pope, DNP, CRNP, FNP-C
• Edward Pratt
• Sara A Primeaux Howell, PHARMD
• Andrew Mark Richardson, DMD
• Meredith Rhodes Roach, PHARM D
• Roberto V Pischek DMD PC
• Robertsdale Nursing Home Inc
• Robertsdale Nursing Home, Inc.

• Family Medicine Physician in Robertsdale, AL
• Providers in Robertsdale, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; 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.