Crossroads | |
160 Broad St Providence RI 02903-4028 | |
(401) 861-2403 | |
(401) 521-1145 |
Full Name | Crossroads |
---|---|
Speciality | Clinic/Center |
Location | 160 Broad St, Providence, Rhode Island |
Authorized Official Name and Position | Gregory Young (VICE PRESIDENT/CHIEF FINANCIAL OFFI) |
Authorized Official Contact | 4014440400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Crossroads 375 Allens Ave Providence RI 02905-5010 Ph: (401) 444-0400 | Crossroads 160 Broad St Providence RI 02903-4028 Ph: (401) 861-2403 |
NPI Number | 1821120924 |
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Provider Enumeration Date | 03/12/2007 |
Last Update Date | 03/29/2017 |
Medicare PECOS PAC ID | 9335050962 |
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Medicare Enrollment ID | O20070810000667 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821120924 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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