1194830323 NPI number — SHS VENTURES, INC

Table of content: (NPI 1194830323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194830323 NPI number — SHS VENTURES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHS VENTURES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIMARY CARE CENTER OF PLAINVILLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194830323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1908
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02862-1908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-729-2836
Provider Business Mailing Address Fax Number:
401-729-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 MESSENGER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02762-2258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-695-9933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIETZ
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
401-729-2130

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9726284 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SH42203 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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