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General NPI Number Information
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NPI Number | 1952390643
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOSPITAL
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 6801 AIRPORT BLVD
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City | MOBILE
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State | AL
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Zip | 36608-3709
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Country | US
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Telephone | 251-633-1600
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Fax | 251-633-1679
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Provider Business Mailing Address
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Address Line | PO BOX 851537
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City | MOBILE
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State | AL
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Zip | 36685-1537
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Country | US
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Telephone | 251-633-1600
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Fax | 251-633-1679
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. TODD S. KENNEDY
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Credential |
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Telephone | 251-633-1663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QL0400X
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Taxonomy Name | Lithotripsy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 10385
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License Number State | AL
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