Provider Demographics
NPI:1891245692
Name:ALABAMA PROVIDENCE HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:ALABAMA PROVIDENCE HEALTHCARE SERVICES
Other - Org Name:THE CANCER CENTER AT PROVIDENCE PARK PET CT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-342-3949
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE A-T01
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-342-3949
Mailing Address - Fax:251-631-3361
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D143
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-342-3949
Practice Address - Fax:251-631-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty