Healthcare Provider Details

I. General information

NPI: 1730613431
Provider Name (Legal Business Name): ALABAMA PROVIDENCE HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 PROVIDENCE PARK DR S
MOBILE AL
36695-4600
US

IV. Provider business mailing address

PO BOX 850489
MOBILE AL
36685-0489
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-3490
  • Fax: 251-660-3491
Mailing address:
  • Phone: 251-342-3949
  • Fax: 251-631-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: YESICA VIEYRA
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 205-939-7633