| Main Street Family Practice | |
|
66 Main St Wakefield RI 02879-3555 | |
| (401) 789-1600 | |
| Not Available |
| Full Name | Main Street Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 66 Main St, Wakefield, Rhode Island |
| Authorized Official Name and Position | John Leon Bossian (PHYSICIAN) |
| Authorized Official Contact | 4017891600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Practice 66 Main St Wakefield RI 02879-3555 Ph: (401) 789-1600 | Main Street Family Practice 66 Main St Wakefield RI 02879-3555 Ph: (401) 789-1600 |
| NPI Number | 1922120054 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 06/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922120054 | NPI | - | NPPES |
| MS46923 | Other | RI | OTHER |
| MS46923 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | DO0391 (Rhode Island) | Primary |
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