NPIMap

Organization Active NPI

Providence Healthcare Services

Doing business as Providence Medical Group

  • Family Medicine Physician
  • Mobile, AL
National Provider Identifier
1215214283
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROVIDENCE HEALTHCARE SERVICES
Doing business as
Providence Medical Group
Practice address
5100 Rangeline Road North
Mobile, AL 36619-9504
Phone
(251) 378-4000
Fax
(251) 378-4006
NPI assigned
Nov 4, 2011
Last updated
Sep 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5100 Rangeline Road North
Mobile, AL 36619-9504

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
529907120MedicaidAL

Other names 1

  • Providence Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Providence Healthcare Services17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347494400000",
    "number": "1215214283",
    "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": "5100 RANGELINE ROAD NORTH",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366199504",
            "telephone_number": "251-378-4000",
            "fax_number": "251-378-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-04",
        "last_updated": "2012-09-13",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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"
        }
    ]
}

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 13, 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.