1093861858 NPI number — RADIATION ONCOLOGY SERVICES OF RHODE ISLAND, LLC

Table of content: (NPI 1093861858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093861858 NPI number — RADIATION ONCOLOGY SERVICES OF RHODE ISLAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIATION ONCOLOGY SERVICES OF RHODE ISLAND, 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:
MADDOCK CENTER FOR RADIATION ONCOLOGY
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:
1093861858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 TOLL GATE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-2715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-732-2300
Provider Business Mailing Address Fax Number:
401-738-3450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 TOLL GATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-2715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-732-2300
Provider Business Practice Location Address Fax Number:
401-738-3450
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADDOCK
Authorized Official First Name:
LUCY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
401-732-2300

Provider Taxonomy Codes

  • Taxonomy code: 261QX0203X , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9003644 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750437448 . This is a "GROUP NPI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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