Healthcare Provider Details

I. General information

NPI: 1609446087
Provider Name (Legal Business Name): ALABAMA PROVIDENCE HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE D436
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE D436
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-1987
  • Fax: 251-266-2070
Mailing address:
  • Phone: 251-266-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA HEMM
Title or Position: ENROLLMENT MANAGER
Credential:
Phone: 904-450-6004