Chan Park Md Inc | |
905 Victory Highway Slatersville RI 02876 | |
(401) 762-2728 | |
(401) 762-0473 |
Full Name | Chan Park Md Inc |
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Speciality | Family Medicine |
Location | 905 Victory Highway, Slatersville, Rhode Island |
Authorized Official Name and Position | Chan Hoon Park (OWNER) |
Authorized Official Contact | 4017622728 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Chan Park Md Inc Po Box 177 905 Victory Hwy Slatersville RI 02876 Ph: (401) 762-2728 | Chan Park Md Inc 905 Victory Highway Slatersville RI 02876 Ph: (401) 762-2728 |
NPI Number | 1104865849 |
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Provider Enumeration Date | 06/06/2006 |
Last Update Date | 02/26/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104865849 | NPI | - | NPPES |
12601 | Other | RI | BLUE CROSS BLUE SHIELD |
9001260 | Medicaid | RI | |
001727 | Other | RI | BCBS BLUE CHIP |
404332 | Other | TUFTS | |
AA26737 | Other | HAVARD PILGRIM | |
0101561 | Other | MA | EVERCARE |
0100118 | Other | UNITED HEALTHCARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | MD5083 (Rhode Island) | Primary |