| Providence Medical Group - Gulf Shores | |
|
1700 W 2nd St Gulf Shores AL 36542-3422 | |
| (251) 342-3949 | |
| (251) 631-3361 |
| Full Name | Providence Medical Group - Gulf Shores |
|---|---|
| Speciality | General Practice |
| Location | 1700 W 2nd St, Gulf Shores, Alabama |
| Authorized Official Name and Position | Todd Kennedy (PRESIDENT) |
| Authorized Official Contact | 2516338880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group - Gulf Shores 6701 Airport Blvd Suite 143 Mobile AL 36608-6705 Ph: (251) 342-3949 | Providence Medical Group - Gulf Shores 1700 W 2nd St Gulf Shores AL 36542-3422 Ph: (251) 342-3949 |
| NPI Number | 1093174286 |
|---|---|
| Provider Enumeration Date | 02/16/2016 |
| Last Update Date | 02/16/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093174286 | NPI | - | NPPES |
| 156183 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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