PROVIDENCE HEALTHCARE SERVICES (NPI# 1255535662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255535662 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTHCARE SERVICES |
| Other Organization Name | PROVIDENCE MEDICAL GROUP |
| Practice Address |
610 Providence Park Dr E Bldg. 1 Suite 102 Mobile AL 36695-4622 |
| Mailing Address |
Po Box 850489 Mobile AL 36685-0489 |
| Practice Telephone | 2513783900 |
| Practice Fax Number | 2513783901 |
| Mailing Telephone | 2513423949 |
| Mailing Fax Number | 2516313361 |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2012-08-27 |
| Authorized Official Name | MR. CLARK P. CHRISTIANSON (PRESIDENT) |
| Authorized Official Telephone | 2516313574 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 529907120 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801188503 | Providence Healthcare Services | Obstetrics & Gynecology | 253 Professional Ln, Gulf Shores, AL 36542-3461 | 2011-05-12 |
| 1912101981 | Providence Healthcare Services | Family Medicine | 6901 Airport Blvd, Mobile, AL 36608-3795 | 2007-06-13 |
| 1902000102 | Providence Healthcare Services | Family Medicine | 19140 S 3rd St, Citronelle, AL 36522-2306 | 2007-06-12 |
| 1700080009 | Providence Healthcare Services | Family Medicine | 18 C.m. Rambo Drive, Saraland, AL 36571-2151 | 2007-06-12 |
| 1740484955 | Providence Healthcare Services | Family Medicine | 8833 Cottage Hill Rd, Mobile, AL 36695-8345 | 2007-06-12 |
| 1124222427 | Providence Healthcare Services | Family Medicine | 5100 Rangeline Road North, Mobile, AL 36619-9504 | 2007-06-12 |
| 1215214283 | Providence Healthcare Services | Family Medicine | 5100 Rangeline Road North, Mobile, AL 36619-9504 | 2011-11-04 |
| 1164683595 | Providence Healthcare Services | Obstetrics & Gynecology | 29653 Anchor Cross Blvd, Daphne, AL 36526-9594 | 2008-06-18 |
| 1679751226 | Providence Healthcare Services | Family Medicine | 18 C.m. Rambo Drive, Saraland, AL 36571-2151 | 2008-02-06 |
| 1013113760 | Providence Healthcare Services | Obstetrics & Gynecology | 6701 Airport Blvd, Suite B127, Mobile, AL 36608-6705 | 2007-06-21 |
| Street Address |
610 PROVIDENCE PARK DR E BLDG. 1 SUITE 102 |
| City | MOBILE |
| State | AL |
| Zip Code | 36695-4622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811990765 | Percy Vandorn Crocker | Otolaryngology | 610 Providence Park Dr E, Bldg 2, Suite 203, Mobile, AL 36695-4622 | 2005-05-24 |
| 1790272250 | Elizabeth Brooke Stewart | Family Medicine | 610 Providence Park Dr E, Mobile, AL 36695-4622 | 2018-04-19 |
| 1598214116 | Carolyn Waddell | Physician Assistant | 610 Providence Park Dr E, Mobile, AL 36695-4622 | 2016-09-23 |
| 1265861355 | Alabama Providence Healthcare Services | Internal Medicine | 610 Providence Park Dr E, Bldg 1, Suite 101, Mobile, AL 36695-4622 | 2013-11-08 |
| 1083043178 | Alabama Providence Healthcare Services | Internal Medicine | 610 Providence Park Dr E, Bldg 1, Suite 102, Mobile, AL 36695-4622 | 2013-11-08 |
| 1811249444 | Dedra Snow | Pharmacist | 610 Providence Park Dr E, Mobile, AL 36695-4622 | 2012-10-05 |
| 1063770709 | Jonathan Michael Holmes | Pediatrics | 610 Providence Park Dr E, Ste. 201, Mobile, AL 36695-4622 | 2012-05-01 |
| 1548460116 | Andrea Lamendola Thompson | Audiologist | 610 Providence Park Dr E, Bldg. 2 Suite 202, Mobile, AL 36695-4622 | 2007-07-23 |
| 1235146499 | Barbara M. Williams | Nurse Practitioner | 610 Providence Park Dr E, Bldg 1 Suite 102, Mobile, AL 36695-4622 | 2006-08-01 |
| 1255345369 | Stephen Anthony Kahalley | Internal Medicine | 610 Providence Park Dr E, Bldg 1 Suite 102, Mobile, AL 36695-4622 | 2006-07-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677596 | Linda Jean Hayes | Counselor | 2146 Carson Court, Mobile, AL 36695 | 2020-10-22 |
| 1205447836 | Restore Therapy Services, Ltd | Physical Therapist | 6720 Grejot Road, Mobile, AL 36695 | 2020-08-17 |
| 1437774999 | Nicholas Alan Brautigam | Chiropractor | 960 Schillinger Rd S, Suite D, Mobile, AL 36695 | 2020-06-10 |
| 1891320412 | R3 Counseling Solutions, LLC | Social Worker | 1110 Hillcrest Road, Suite 1b, Mobile, AL 36695 | 2020-03-04 |
| 1649800079 | Tondalaya Denise Mack | Home Health | 1450 Leroy Stevens Rd, Apt35, Mobile, AL 36695 | 2020-01-24 |
| 1801367107 | Tera Walters Therapy LLC | Pediatrics | 2523 D'iberville Drive North, Mobile, AL 36695 | 2018-12-12 |
| 1023595279 | Hall & Oates Pt West Mobile, LLC | Physical Therapist | 2351 Dawes Road, Mobile, AL 36695 | 2018-07-20 |
| 1679069116 | Oculo-facial Consultants | Ophthalmology | 610 Providence Park Dr E Bldg 2, Mobile, AL 36695 | 2018-07-09 |
| 1669964318 | Tina Highsmith | Hearing Instrument Specialist | 2344 Schillinger Rd S, Building #2 Ste A, Mobile, AL 36695 | 2018-05-30 |
| 1023533858 | Reach Pediatric Therapy | Speech-Language Pathologist | 12485 Jeff Hamilton Rd, Mobile, AL 36695 | 2017-08-14 |
| Find all providers in zip 36695 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962856732 | Timothy Kennedy | Internal Medicine | 6701 Airprot Blvd, Ste A101, Mobile, AL 36608-0000 | 2016-04-19 |
| 1902269400 | Cesar Moreno | Internal Medicine | 2451 University Hospital Dr Rm 714, Mobile, AL 36617 | 2016-04-01 |
| 1770979882 | Mason Gabriel Adams | Internal Medicine | 75 S University Blvd Ste 6000-b, Mobile, AL 36608-3271 | 2015-04-15 |
| 1083009930 | Mark Owusu | Internal Medicine | 2451 Fillingim St # 7th, Mobile, AL 36617 | 2015-03-30 |
| 1730573627 | Theresa Yarbrough | Internal Medicine | 75 S University Blvd Ste 6000-a, Mobile, AL 36608-3042 | 2015-03-27 |
| 1346689163 | Benjamin Ross Niland | Internal Medicine | 75 S University Blvd Unit 6000, Mobile, AL 36608-3274 | 2013-06-14 |
| 1902249303 | Symbol Health Solutions, LLC | Internal Medicine | 3765b Government Blvd, Mobile, AL 36693-4307 | 2013-04-16 |
| 1629411731 | Adhd Medical Clinic of Mobile, P.C. | Internal Medicine | 2404 Spring Hill Ave, Unit 114, Mobile, AL 36607-3029 | 2013-04-09 |
| 1578826293 | Waqar Ahmed Siddiqui | Internal Medicine | 2451 Fillingim St Ste 10g, Mobile, AL 36617-2238 | 2012-06-18 |
| 1972860641 | Katrina Alexis Chapman | Internal Medicine | 2451 Fillingim St Rm 714, Mobile, AL 36617-2238 | 2012-04-18 |
| Find all providers in MOBILE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.