Healthcare Provider Details

I. General information

NPI: 1841543071
Provider Name (Legal Business Name): ASCENSION HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD A101
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD A101
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-8880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1-069585
License Number StateAL

VIII. Authorized Official

Name: MR. CLARK CHRISTIANSON
Title or Position: CEO
Credential:
Phone: 251-633-1000