Healthcare Provider Details

I. General information

NPI: 1467478156
Provider Name (Legal Business Name): PAWTUXET VALLEY MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 TIOGUE AVE
COVENTRY RI
02816-6167
US

IV. Provider business mailing address

982 TIOGUE AVE
COVENTRY RI
02816-6167
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-6800
  • Fax: 401-823-9203
Mailing address:
  • Phone: 401-821-6800
  • Fax: 401-823-9203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL F. COLLINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-821-6800