1275514093 NPI number — RJ HOLDING COMPANY LLC

Table of content: (NPI 1275514093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275514093 NPI number — RJ HOLDING COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RJ HOLDING COMPANY LLC
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:
WOMENS MEDICAL CENTER OF RI
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:
1275514093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 BROAD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-467-9111
Provider Business Mailing Address Fax Number:
401-461-1390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-467-9111
Provider Business Practice Location Address Fax Number:
401-461-1390
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DIORIO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR/OWNER
Authorized Official Telephone Number:
401-467-9111

Provider Taxonomy Codes

  • Taxonomy code: 261QA0005X , with the licence number:  1001 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QF0050X , with the licence number: 1001 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X , with the licence number: 1001 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002427 . This is a "BLUECHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: W034514 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5715 . This is a "BLUE CROSS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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