| Providence Medical Group | |
|
18317 Us Hwy 90 Robertsdale AL 36567 | |
| (251) 947-2000 | |
| (251) 947-5399 |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 18317 Us Hwy 90, Robertsdale, Alabama |
| Authorized Official Name and Position | Clark P. Christianson (PRESIDENT) |
| Authorized Official Contact | 2516313574 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Po Box 850489 Mobile AL 36685-0489 Ph: (251) 342-3949 | Providence Medical Group 18317 Us Hwy 90 Robertsdale AL 36567 Ph: (251) 947-2000 |
| NPI Number | 1184742363 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 08/27/2012 |
| Medicare PECOS PAC ID | 3173425121 |
|---|---|
| Medicare Enrollment ID | O20040121001045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184742363 | NPI | - | NPPES |
| 529907120 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Alabama) | Primary |
| 207R00000X | Internal Medicine | (Alabama) | Secondary |
| Provider Name | Robert N Capper |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1477577757 PECOS PAC ID: 4284669359 Enrollment ID: I20050928000665 |
| Provider Name | Thomas W Bender |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1649266792 PECOS PAC ID: 6507817202 Enrollment ID: I20080707000529 |
| Provider Name | Syeda Shaista Rumman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770705204 PECOS PAC ID: 7113043928 Enrollment ID: I20100929001447 |
| Provider Name | Timothy M Iliff |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1366603748 PECOS PAC ID: 0042469363 Enrollment ID: I20121002000402 |
Imc-central Baldwin Physicians Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 18317 Us 90, Robertsdale, AL 36567 Phone: 251-947-2000 | |
Third Coast Optical, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 22835 State Highway 59 S Ste D, Robertsdale, AL 36567 Phone: 251-923-8684 |