| |
593 Eddy St Providence RI 02903-4923 | |
(401) 444-5640 | |
(401) 444-5462 |
Full Name | |
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Speciality | Clinic/center |
Location | 593 Eddy St, Providence, Rhode Island |
Authorized Official Name and Position | Peter K Markell (CFO) |
Authorized Official Contact | 4014447914 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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117 Ellenfield St Providence RI 02905-4513 Ph: (401) 444-5640 | 593 Eddy St Providence RI 02903-4923 Ph: (401) 444-5640 |
NPI Number | 1346470556 |
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Provider Enumeration Date | 07/22/2009 |
Last Update Date | 04/05/2023 |
Identifier | Type | State | Issuer |
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1346470556 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | HOS00121 (Rhode Island) | Primary |
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