Healthcare Provider Details

I. General information

NPI: 1891245692
Provider Name (Legal Business Name): ALABAMA PROVIDENCE HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD SUITE D143
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD SUITE A-T01
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-3949
  • Fax: 251-631-3361
Mailing address:
  • Phone: 251-342-3949
  • Fax: 251-631-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ERICA MADISON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 251-342-3949