MEDICARE: NORTH PROVIDENCE MEDICAL SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center	MD10188	RI
2	332B00000X	Durable Medical Equipment & Medical Supplies	MD05562	RI
3	261QU0200X	Urgent Care Clinic/Center	MD05562	RI

General Provider Information

NPI Number	:	1992757017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PROVIDENCE MEDICAL SERVICES, INC

Provider Business Mailing Address
First Line	:	1637 MINERAL SPRING AVE
Second Line	:	SUITE 115
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4042
Country	:	US
Telephone Number	:	401-353-1012
Fax Number	:	401-353-6362

Provider Business Practice Location Address
First Line	:	1637 MINERAL SPRING AVE
Second Line	:	SUITE 115
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4042
Country	:	US
Telephone Number	:	401-353-1012
Fax Number	:	401-353-6362

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEPHEN D'AMATO
Credential	:	M.D.
Telephone Number	:	401-353-1012

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/07/2008

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