Healthcare Provider Details

I. General information

NPI: 1043804628
Provider Name (Legal Business Name): PROVIDENCE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD BLDG B
MOBILE AL
36608-6705
US

IV. Provider business mailing address

1130 22ND ST S STE 1000
BIRMINGHAM AL
35205-2881
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-2883
  • Fax:
Mailing address:
  • Phone: 205-212-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN HEDRICK
Title or Position: DIRECTOR NET REVENUE MANAGEMENT
Credential:
Phone: 205-212-6652