PROVIDENCE HEALTHCARE SERVICES (NPI# 1801188503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801188503 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTHCARE SERVICES |
| Other Organization Name | PROVIDENCE MEDICAL GROUP |
| Practice Address |
253 Professional Ln Gulf Shores AL 36542-3461 |
| Mailing Address |
Po Box 850489 Mobile AL 36685-0489 |
| Practice Telephone | 2516313490 |
| Practice Fax Number | 2516313461 |
| Mailing Telephone | 2513423949 |
| Mailing Fax Number | 2516313361 |
| Enumeration Date | 2011-05-12 |
| 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 | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
940365 | TX | 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 |
|---|---|---|---|---|
| 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 |
| 1386848356 | Providence Healthcare Services | Internal Medicine | 6701 Airport Blvd, Suite A101, Mobile, AL 36608-6705 | 2007-06-13 |
| Street Address |
253 PROFESSIONAL LN |
| City | GULF SHORES |
| State | AL |
| Zip Code | 36542-3461 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326382276 | Sawrie Oncology Inc | Radiology | 253 Professional Ln, Gulf Shores, AL 36542-3461 | 2012-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073169843 | Mary P Nasello | Technician | 11352 Kelly Ln., Gulf Shores, AL 36542 | 2019-08-16 |
| 1174184915 | Luce Dental Inc. | Clinic/Center | 2025 West 1st St, Gulf Shores, AL 36542 | 2019-06-24 |
| 1699222752 | Jamie M Hayes | Pharmacist | 1527 Gulf Shores Parkway, Gulf Shores, AL 36542 | 2016-09-07 |
| 1265854210 | Mary Edwards | Dentist | 105 West 14th Ave, Gulf Shores, AL 36542 | 2014-01-10 |
| 1629414594 | William Murray Hodge | Counselor | 1401 1st Street, Gulf Shores, AL 36542 | 2013-05-17 |
| 1669720405 | James V Shamburger, Dmd, PC | Dentist | 208 W 19th Ave, Gulf Shores, AL 36542 | 2012-08-28 |
| 1194093658 | Pamela O. Edwards | Dentist | 105 West 14th Avenue, Gulf Shores, AL 36542 | 2011-12-12 |
| 1700198132 | Alycia Marie Kapiotis | Nurse Practitioner | 7293 Roscoe Rd, Gulf Shores, AL 36542 | 2010-07-14 |
| 1699946855 | Dr. Lyle Keith Cooper | Chiropractor | 3325 Gulf Shores Parkway, Gulf Shores, AL 36542 | 2008-03-17 |
| 1780803387 | Lucy Hazebrook | Pharmacist | 1527 Highway 59 South, Gulf Shores, AL 36542 | 2007-04-24 |
| Find all providers in zip 36542 | ||||
| Taxonomy Code | 207VX0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecologic Oncology |
| An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386087559 | David Warren Doo | Obstetrics & Gynecology | 619 19th St S # Wif10250, Birmingham, AL 35249-2570 | 2013-04-08 |
| 1730131210 | Rodney P Rocconi | Obstetrics & Gynecology | 1660 Springhill Avenue, Mobile, AL 36640-0430 | 2006-05-16 |
| 1033168547 | Mack N Barnes | Obstetrics & Gynecology | 500 Office Park Dr Ste 400, Mountain Brk, AL 35223-2457 | 2006-05-10 |
| 1023098571 | Tennessee Valley Gynecologic Oncology, PC | Obstetrics & Gynecology | 3601 Cci Drive, Suite 220, Huntsville, AL 35805 | 2006-01-20 |
| 1639174014 | Kenneth Carl Brewington | Obstetrics & Gynecology | 5 Mobile Infirmary Cir, Mobile, AL 36607-3513 | 2005-06-14 |
| 1154701530 | Jillian A O'donnell | Obstetrics & Gynecology | 625 19th St S, Birmingham, AL 35233-1900 | 2015-06-01 |
| 1104183938 | Haller Jackson Smith | Obstetrics & Gynecology | 619 19th St S, Birmingham, AL 35249-1900 | 2012-04-18 |
| 1811209703 | Margaret Liang | Obstetrics & Gynecology | 1700 6th Ave S, Birmingham, AL 35233-1802 | 2010-07-08 |
| 1437309283 | Rebecca Arend | Obstetrics & Gynecology | 619 19th St S, Birmingham, AL 35249-3720 | 2008-09-29 |
| 1164683595 | Providence Healthcare Services | Obstetrics & Gynecology | 29653 Anchor Cross Blvd, Daphne, AL 36526-9594 | 2008-06-18 |
| Find all providers with the same taxonomy | ||||
| City | GULF SHORES |
| Zip Code | 36542 |
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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.