Healthcare Provider Details

I. General information

NPI: 1881061919
Provider Name (Legal Business Name): RHODE ISLAND MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 MAIN ST 201
EAST GREENWICH RI
02818-3888
US

IV. Provider business mailing address

58 MAIN ST 201
EAST GREENWICH RI
02818-3888
US

V. Phone/Fax

Practice location:
  • Phone: 401-622-4488
  • Fax: 718-554-1666
Mailing address:
  • Phone: 401-622-4488
  • Fax: 718-554-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXANDER E ISTOMIN
Title or Position: ADMINISTRATOR
Credential: MD, MS
Phone: 401-622-4488