Misissippi Providence Healthcare Services, INC.
Family Medicine in Moss Point, MS. Organization (NPI-2).
NPI number1639429970
StatusActive
Last updated in NPPESJan 22, 2013
Details
- NPI
- 1639429970
- Entity type
- Organization (NPI-2)
- Legal business name
- Misissippi Providence Healthcare Services, INC.
- Organization subpart
- No
- Enumeration date
- Sep 13, 2012
- Last updated
- Jan 22, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | AL | Yes |
Practice location
5907 Highway 90Moss Point, MS 39563-6536
Phone 228-769-2611 · Fax 228-762-1638
Mailing address
Po Box 850489Mobile, AL 36685-0489
Phone 251-342-3949 · Fax 251-631-3361
Authorized official
Clark P. Christianson
President
2516313574
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