| Providence Medical Group | |
|
19140 S 3rd St Citronelle AL 36522-2306 | |
| (251) 866-0086 | |
| (251) 866-0089 |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 19140 S 3rd St, Citronelle, Alabama |
| 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 |
|---|---|
| Providence Medical Group Po Box 850489 Mobile AL 36685-0489 Ph: (251) 342-3949 | Providence Medical Group 19140 S 3rd St Citronelle AL 36522-2306 Ph: (251) 866-0086 |
| NPI Number | 1902000102 |
|---|---|
| Provider Enumeration Date | 06/12/2007 |
| Last Update Date | 08/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902000102 | NPI | - | NPPES |
| 529907120 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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Providence Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 19140 S 3rd St, Citronelle, AL 36522 Phone: 251-866-0086 Fax: 251-866-0089 |