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142a Danielson Pike Foster RI 02825-1475 | |
(401) 647-3702 | |
(401) 647-5380 |
Full Name | |
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Speciality | Clinic/Center |
Location | 142a Danielson Pike, Foster, Rhode Island |
Authorized Official Name and Position | Peter J Bancroft (PRESIDENT & CEO) |
Authorized Official Contact | 4012855119 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 312 Pascoag RI 02859 Ph: (401) 568-7664 | 142a Danielson Pike Foster RI 02825-1475 Ph: (401) 647-3702 |
NPI Number | 1821254525 |
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Provider Enumeration Date | 08/01/2008 |
Last Update Date | 10/21/2011 |
Medicare PECOS PAC ID | 1355250663 |
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Medicare Enrollment ID | O20080821000540 |
Identifier | Type | State | Issuer |
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1821254525 | NPI | - | NPPES |
NC50602 | Medicaid | RI |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |