Healthcare Provider Details

I. General information

NPI: 1407871270
Provider Name (Legal Business Name): MIDLAND MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 OAKLAWN AVE
CRANSTON RI
02920
US

IV. Provider business mailing address

1312 OAKLAWN AVE
CRANSTON RI
02920
US

V. Phone/Fax

Practice location:
  • Phone: 401-463-3380
  • Fax: 401-463-3308
Mailing address:
  • Phone: 401-463-3380
  • Fax: 401-463-3308

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7006274
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1276020001
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateRI

VIII. Authorized Official

Name: STEPHEN R BEAUPRE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 401-463-3380