Healthcare Provider Details

I. General information

NPI: 1639361744
Provider Name (Legal Business Name): MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MESSENGER ST
PLAINVILLE MA
02762-2258
US

IV. Provider business mailing address

111 BREWSTER ST
PAWTUCKET RI
02860-4400
US

V. Phone/Fax

Practice location:
  • Phone: 508-695-9933
  • Fax:
Mailing address:
  • Phone: 401-729-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. FRANCIS R DIETZ
Title or Position: PRESIDENT-CEO
Credential:
Phone: 401-729-2000