PROVIDENCE MEDICAL GROUP – NPI #1184742363
Family Medicine

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

PROVIDENCE MEDICAL GROUP is a provider located in ROBERTSDALE, AL. NPPES has assigned the NPI number 1184742363 to PROVIDENCE MEDICAL GROUP on March 27, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “PROVIDENCE MEDICAL GROUP” is a dba name, the actual legal business name for this organization is PROVIDENCE HEALTHCARE SERVICES. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207Q00000X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine.

The NPI profile was previously updated about 14 years ago on Aug 27, 2012. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PROVIDENCE MEDICAL GROUP below.

NPI Profile for
PROVIDENCE HEALTHCARE SERVICES

NPI Number
1184742363
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PROVIDENCE HEALTHCARE SERVICES
Doing Business As (dba): PROVIDENCE MEDICAL GROUP
Primary location
18317 US HWY 90
ROBERTSDALE, AL 36567
Phone: (251) 947-2000 Fax: (251) 947-5399
Mailing address
PO BOX 850489
MOBILE, AL 36685-0489
Phone: (251) 342-3949 Fax: (251) 631-3361
Organization Subpart
No
Authorized Official
CLARK CHRISTIANSON
PRESIDENT
Phone: (251) 631-3574
Updated
Identifiers

Identifiers for PROVIDENCE MEDICAL GROUP

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDAL529907120
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207Q00000X
- Family Medicine (Primary)
AL
207R00000X
- Internal Medicine
AL

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.