Full Name | |
---|---|
Speciality | Clinic/center |
Location | 14 Rock Ave, Pascoag, Rhode Island |
Authorized Official Name and Position | Peter J Bancroft (PRESIDENT/CEO) |
Authorized Official Contact | 4012855119 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 312 Pascoag RI 02859-0312 Ph: (401) 567-0800 | 14 Rock Ave Pascoag RI 02859-0152 Ph: (401) 568-2549 |
NPI Number | 1932478146 |
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Provider Enumeration Date | 12/16/2011 |
Last Update Date | 12/16/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932478146 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |