North Main | |
530 N Main St Providence RI 02904-5762 | |
(401) 415-9500 | |
(401) 415-9515 |
Full Name | North Main |
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Speciality | Clinic/Center |
Location | 530 N Main St, Providence, Rhode Island |
Authorized Official Name and Position | Gregory Young (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4014440400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
North Main 375 Allens Ave Providence RI 02905-5010 Ph: (401) 444-0400 | North Main 530 N Main St Providence RI 02904-5762 Ph: (401) 415-9500 |
NPI Number | 1558650986 |
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Provider Enumeration Date | 04/06/2011 |
Last Update Date | 03/29/2017 |
Medicare PECOS PAC ID | 9335050962 |
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Medicare Enrollment ID | O20110719000179 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558650986 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | ACF01609 (Rhode Island) | Primary |
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