1962654426 NPI number — A WAKEFIELD WALK-IN & PRIMARY CARE LLC

Table of content: (NPI 1962654426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962654426 NPI number — A WAKEFIELD WALK-IN & PRIMARY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A WAKEFIELD WALK-IN & PRIMARY CARE LLC
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:
BALD HILL WALK-IN
Provider Other Organization Name Type Code:
3
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:
1962654426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
553 KINGSTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02879-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-932-5526
Provider Business Mailing Address Fax Number:
401-789-1327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
553 KINGSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02879-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-932-5526
Provider Business Practice Location Address Fax Number:
401-789-1327
Provider Enumeration Date:
10/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EDEN
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
401-284-1515

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com