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Providence Healthcare Services

Organization Active NPI Internal Medicine Physician · Mobile, AL

NPI 1497959613 · NPPES record last updated May 9, 2017

Key facts

NPI
1497959613
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
PROVIDENCE HEALTHCARE SERVICES
Practice address
5621 Cottage Hill Rd
Mobile, AL 36609-4210
Phone
(251) 666-2439
Fax
(251) 666-3166
NPI assigned
Jun 12, 2007
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 16

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

National Provider Directory

Tax ID family
Providence Healthcare Services (17 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207R00000X Yes

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

IdentifierTypeStateIssuer
529907120MedicaidAL

Other names

  • Providence Medical Group Doing business as

Other providers in Mobile, AL

All providers in Mobile, AL · Internal Medicine Physician in Alabama

Sources for this page

Verify at the official NPI Registry.