1073973574 NPI number — OCEAN STATE URGENT CARE CENTER OF WOONSOCKET

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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)