| Misissippi Providence Healthcare Services, Inc. | |
|
5907 Highway 90 Moss Point MS 39563-6536 | |
| (228) 769-2611 | |
| (228) 762-1638 |
| Full Name | Misissippi Providence Healthcare Services, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 5907 Highway 90, Moss Point, Mississippi |
| Authorized Official Name and Position | Clark P. Christianson (PRESIDENT) |
| Authorized Official Contact | 2516313574 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Misissippi Providence Healthcare Services, Inc. Po Box 850489 Mobile AL 36685-0489 Ph: (251) 342-3949 | Misissippi Providence Healthcare Services, Inc. 5907 Highway 90 Moss Point MS 39563-6536 Ph: (228) 769-2611 |
| NPI Number | 1639429970 |
|---|---|
| Provider Enumeration Date | 09/13/2012 |
| Last Update Date | 01/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639429970 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Alabama) | Primary |
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