Provider Demographics
NPI:1326242066
Name:PROVIDENCE HEALTHCARE SVC
Entity Type:Organization
Organization Name:PROVIDENCE HEALTHCARE SVC
Other - Org Name:PROVIDENCE OPEN MRI
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:PO BOX 850489
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0489
Mailing Address - Country:US
Mailing Address - Phone:251-639-5070
Mailing Address - Fax:251-634-2994
Practice Address - Street 1:6901 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3795
Practice Address - Country:US
Practice Address - Phone:251-639-5070
Practice Address - Fax:251-634-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)