Healthcare Provider Details

I. General information

NPI: 1952390643
Provider Name (Legal Business Name): PROVIDENCE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

PO BOX 851537
MOBILE AL
36685-1537
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-1600
  • Fax: 251-633-1679
Mailing address:
  • Phone: 251-633-1600
  • Fax: 251-633-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number10385
License Number StateAL

VIII. Authorized Official

Name: MR. TODD S. KENNEDY
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 251-633-1663