| Wickford Family Practice Llc | |
|
320 Phillips St Ste 102 North Kingstown RI 02852-5149 | |
| (603) 667-6765 | |
| Not Available |
| Full Name | Wickford Family Practice Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 320 Phillips St Ste 102, North Kingstown, Rhode Island |
| Authorized Official Name and Position | Maxwell Hogue (OWNER) |
| Authorized Official Contact | 6036676765 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wickford Family Practice Llc 619 Boston Neck Rd North Kingstown RI 02852-6235 Ph: (603) 667-6765 | Wickford Family Practice Llc 320 Phillips St Ste 102 North Kingstown RI 02852-5149 Ph: (603) 667-6765 |
| NPI Number | 1710698667 |
|---|---|
| Provider Enumeration Date | 12/12/2022 |
| Last Update Date | 02/01/2023 |
| Medicare PECOS PAC ID | 6305218876 |
|---|---|
| Medicare Enrollment ID | O20230209000992 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710698667 | NPI | - | NPPES |
| 1235789231 | Medicaid | RI | |
| APRN02399 | Other | RI | STATE NP LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Maxwell Hogue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235789231 PECOS PAC ID: 4981033073 Enrollment ID: I20201030002500 |
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