NPIMap

Organization Active NPI

Alabama Providence Healthcare Services

Doing business as Providence Medical Group - Pediatrics

  • Pediatrics Physician
  • Mobile, AL
National Provider Identifier
1730613431
Registry record updated Feb 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ALABAMA PROVIDENCE HEALTHCARE SERVICES
Doing business as
Providence Medical Group - Pediatrics
Practice address
6908 Providence Park Dr S
Mobile, AL 36695-4600
Phone
(251) 660-3490
Fax
(251) 660-3491
NPI assigned
Apr 19, 2017
Last updated
Feb 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2019

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

Authorized official

Name
Yesica Vieyra
Title
Credentialing Specialist
Phone
(205) 939-7633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

6908 Providence Park Dr S
Mobile, AL 36695-4600

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
156183MedicaidAL

Other names 1

  • Providence Medical Group - Pediatrics 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": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550188800000",
    "number": "1730613431",
    "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": "6908 PROVIDENCE PARK DR S",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366954600",
            "telephone_number": "251-660-3490",
            "fax_number": "251-660-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA PROVIDENCE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2019-02-15",
        "status": "A",
        "authorized_official_last_name": "VIEYRA",
        "authorized_official_first_name": "YESICA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "205-939-7633"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "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 - Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group - Pediatrics",
            "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 Feb 15, 2019; 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.