NPIMap

Organization Active NPI

Mississippi Providence Healthcare Services Inc.

  • Family Medicine Physician
  • Mobile, AL
National Provider Identifier
1821340407
Registry record updated Oct 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MISSISSIPPI PROVIDENCE HEALTHCARE SERVICES INC.
Practice address
6701 Airport Blvd
Suite D430
Mobile, AL 36608-6705
Phone
(251) 342-3949
Fax
(251) 631-3361
NPI assigned
Oct 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 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) 633-1660

Specialties & licenses 1

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

Addresses

Primary practice location

6701 Airport Blvd
Suite D430
Mobile, AL 36608-6705

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121108000396 MS Part B Supplier - Clinic/Group Practice 8729239371 Receives reassigned benefits from 10 practitioners
Practice locations: Moss Point, MS

National Provider Directory

National Provider Directory
Tax ID family
Misissippi Providence Healthcare Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1821340407",
    "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": "6701 AIRPORT BLVD",
            "address_2": "SUITE D430",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086705",
            "telephone_number": "251-342-3949",
            "fax_number": "251-631-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI PROVIDENCE HEALTHCARE SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-10-08",
        "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": "251-633-1660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.