1174525166 NPI number — MEDICAL ASSOCIATES OF RHODE ISLAND, INC.

Table of content: (NPI 1174525166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174525166 NPI number — MEDICAL ASSOCIATES OF RHODE ISLAND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ASSOCIATES OF RHODE ISLAND, 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:
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:
1174525166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1180 HOPE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02809-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-253-8900
Provider Business Mailing Address Fax Number:
401-253-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 HOPE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02809-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-253-8900
Provider Business Practice Location Address Fax Number:
401-253-3131
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARROP
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-253-8900

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , 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: 101-6 . This is a "B/C" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 101-6 . This is a "BCHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4072 . This is a "NEIGHBORHOOD HEALRH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1600201 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 625025 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: MA01678 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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