Healthcare Provider Details

I. General information

NPI: 1013302488
Provider Name (Legal Business Name): OCEAN STATE URGENT CARE CENTER OF COVENTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 TIOGUE AVE
COVENTRY RI
02816-6116
US

IV. Provider business mailing address

982 TIOGUE AVE
COVENTRY RI
02816-6116
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN H. MARTIN
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 401-821-6800