1487649430 NPI number — THE MIRIAM HOSPITAL

Table of content: (NPI 1487649430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487649430 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:
1487649430
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:
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:
401-444-5640
Provider Business Mailing Address Fax Number:
401-444-5862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
164 SUMMIT AVE
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:
02906-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-6966
Provider Business Practice Location Address Fax Number:
401-444-5462
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  122 , 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: 1937 . This is a "NHPRI HOSPITAL PROV ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 900949 . This is a "TUFTS OP PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: RI0017 . This is a "HEALTHNET NORTH EAST PROV" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: H00108 . This is a "BLUE CHIP RI PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4100012 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900197 . This is a "HARVARD HLTH PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 994559 . This is a "CONNECTICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: A0290600 . This is a "JOHN DEERE PROV ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1512083 . This is a "GATEWAY HLTH PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5000417 . This is a "UHCNE HOSPITAL PROV ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 802308 . This is a "MVP PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0008269 . This is a "NHPMA HOSPITAL PROV ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: OP00012 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000000004 . This is a "BCBSRI HOSPITAL PROV ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000022028 . This is a "BOSTON MED CTR PROV ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0007373 . This is a "AETNA HOSPITAL PROV ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 904801 . This is a "TUFTS INPT PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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