1225073638 NPI number — THE MIRIAM HOSPITAL

Table of content: (NPI 1225073638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225073638 NPI number — THE MIRIAM HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MIRIAM HOSPITAL
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:
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:
1225073638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 ELLENFIELD ST
Provider Second Line Business Mailing Address:
SUITE 101, CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02905-4513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-444-6779
Provider Business Mailing Address Fax Number:
401-444-6912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
146 W RIVER ST STE 11A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02904-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-793-8770
Provider Business Practice Location Address Fax Number:
401-793-8709
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARKELL
Authorized Official First Name:
PETER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EVP & CFO
Authorized Official Telephone Number:
401-444-7914

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0809X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1225073638 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MI72815 - PSYCH , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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