1881604940 NPI number — TOLL GATE RADIOLOGY INC

Table of content: (NPI 1881604940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881604940 NPI number — TOLL GATE RADIOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOLL GATE RADIOLOGY 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:
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:
1881604940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 TOLL GATE RD
Provider Second Line Business Mailing Address:
STE 109
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-4458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-738-3100
Provider Business Mailing Address Fax Number:
401-738-8505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 TOLL GATE RD
Provider Second Line Business Practice Location Address:
STE 101A, STE 102
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-738-3100
Provider Business Practice Location Address Fax Number:
401-738-8505
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRUZZESE
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-738-3100

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , with the licence number:  RAD0066 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085D0003X , with the licence number: RAD0066 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X , with the licence number: RAD0066 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , with the licence number: RAD0066 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: RAD0066 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: RAD0066 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: RAD0066 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X , with the licence number: RAD0066 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9001570 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1570-5 . This is a "BCBS KENT HOSP PROVIDER N" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2188604 . This is a "AETNA OFFICE PROVIDER NO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2203 . This is a "NEIGHBORHOOD H PLAN PROVI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1742251 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: CD2379 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9001198 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1198-5 . This is a "BCBS OFFICE PROVIDER NO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 703058 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 50356624 . This is a "UNICARE LIFE AND HLTH INS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5144133 . This is a "AETNA KENT HOSPITAL PROV" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 68453 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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