| Green Line Express Llc | |
|
245 Main St Wakefield RI 02879-3527 | |
| (401) 360-3500 | |
| Not Available |
| Full Name | Green Line Express Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 245 Main St, Wakefield, Rhode Island |
| Authorized Official Name and Position | Christina Procaccianti (FACILITY ADMINISTRATOR) |
| Authorized Official Contact | 4013603200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Line Express Llc 245 Main St Wakefield RI 02879-3527 Ph: () - | Green Line Express Llc 245 Main St Wakefield RI 02879-3527 Ph: (401) 360-3500 |
| NPI Number | 1043989288 |
|---|---|
| Provider Enumeration Date | 09/10/2021 |
| Last Update Date | 09/10/2021 |
| Medicare PECOS PAC ID | 2062819204 |
|---|---|
| Medicare Enrollment ID | O20210930001339 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043989288 | NPI | - | NPPES |
| 01645 | Other | RI | AMBULATORY CARE FACILITY LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Lisa S Rameaka |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871609362 PECOS PAC ID: 5991764201 Enrollment ID: I20041008000457 |
| Provider Name | Margaret A Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134145097 PECOS PAC ID: 8921166729 Enrollment ID: I20081023000232 |
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