Provider Demographics
NPI:1184852063
Name:PROVIDENCE HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:PROVIDENCE HEALTHCARE SERVICES, INC.
Other - Org Name:GULF COAST DERMATOLOGY AND SKIN CARE CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-342-3949
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D232
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-631-3570
Mailing Address - Fax:251-631-3572
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D232
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-631-3570
Practice Address - Fax:251-631-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty