NPIMap

Organization Active NPI

Providence Healthcare Services

Doing business as Providence Medical Group

  • Internal Medicine Physician
  • Mobile, AL
National Provider Identifier
1497959613
Registry record updated May 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PROVIDENCE HEALTHCARE SERVICES
Doing business as
Providence Medical Group
Practice address
5621 Cottage Hill Rd
Mobile, AL 36609-4210
Phone
(251) 666-2439
Fax
(251) 666-3166
NPI assigned
Jun 12, 2007
Last updated
May 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2017

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

Authorized official

Name
Mr. Todd Kennedy
Title
President
Phone
(251) 631-3574

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

5621 Cottage Hill Rd
Mobile, AL 36609-4210

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": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494288000000",
    "number": "1497959613",
    "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": "5621 COTTAGE HILL RD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366094210",
            "telephone_number": "251-666-2439",
            "fax_number": "251-666-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2017-05-09",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-631-3574",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal 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 May 9, 2017; 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.