Healthcare Provider Details

I. General information

NPI: 1326242066
Provider Name (Legal Business Name): PROVIDENCE HEALTHCARE SVC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 AIRPORT BLVD
MOBILE AL
36608-3795
US

IV. Provider business mailing address

PO BOX 850489
MOBILE AL
36685-0489
US

V. Phone/Fax

Practice location:
  • Phone: 251-639-5070
  • Fax: 251-634-2994
Mailing address:
  • Phone: 251-639-5070
  • Fax: 251-634-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY L OSHEA
Title or Position: BILLING OFFICE MANAGER
Credential:
Phone: 251-342-3949