1073973574 NPI number — OCEAN STATE URGENT CARE CENTER OF WOONSOCKET

Table of content: (NPI 1073973574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073973574 NPI number — OCEAN STATE URGENT CARE CENTER OF WOONSOCKET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN STATE URGENT CARE CENTER OF WOONSOCKET
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:
OCEAN STATE PRIMARY CARE OF WOONSOCKET
Provider Other Organization Name Type Code:
5
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:
1073973574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 JOHN A CUMMINGS WAY
Provider Second Line Business Mailing Address:
3RD FLOOR; SUITE 301
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-235-7310
Provider Business Mailing Address Fax Number:
401-235-7314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 JOHN A CUMMINGS WAY
Provider Second Line Business Practice Location Address:
3RD FLOOR; SUITE 301
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-235-7310
Provider Business Practice Location Address Fax Number:
401-235-7314
Provider Enumeration Date:
02/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ZUBA
Authorized Official First Name:
JEN
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
401-235-7310

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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