| Providence Medical Group | |
|
18 C.m. Rambo Drive Saraland AL 36571-2151 | |
| (251) 675-7433 | |
| (251) 675-3470 |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 18 C.m. Rambo Drive, Saraland, Alabama |
| Authorized Official Name and Position | Clark P. Christianson (PRESIDENT) |
| Authorized Official Contact | 2516331660 |
| 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 18 C.m. Rambo Drive Saraland AL 36571-2151 Ph: (251) 675-7433 |
| NPI Number | 1700080009 |
|---|---|
| Provider Enumeration Date | 06/12/2007 |
| Last Update Date | 09/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700080009 | NPI | - | NPPES |
| 529907120 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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