Providence Healthcare Services
Organization Active NPI Family Medicine Physician · Citronelle, AL
NPI 1902000102 · NPPES record last updated Aug 27, 2012
Key facts
- NPI
- 1902000102
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- PROVIDENCE HEALTHCARE SERVICES
- Practice address
- 19140 S 3Rd St
Citronelle, AL 36522-2306 - Phone
- (251) 866-0086
- Fax
- (251) 866-0089
- NPI assigned
- Jun 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Clark P. Christianson
- Title
- President
- Phone
- (251) 631-3574
Corporate family (same tax ID) 16
National Provider Directory
- Tax ID family
- Providence Healthcare Services
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
19140 S 3Rd St
Citronelle, AL 36522-2306
Mailing address
PO Box 850489
Mobile, AL 36685-0489
Phone (251) 342-3949
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 529907120 | Medicaid | AL |
Other names
- Providence Medical Group
Other providers in Citronelle, AL
- Mobile County Board of Health
- Natchez Medical Supply, LLC
- Nursetel
- Nursetel
- Rozalia Mandras Pitruzzello
- Corey Raybon
- Rebecca Reid
- Jerri Riggins
- Kristin Leresa Smith
- Nancy Ursprung
All providers in Citronelle, AL · Family Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.