Healthcare Provider Details

I. General information

NPI: 1295818078
Provider Name (Legal Business Name): EAST PROVIDENCE EMERGENCY ROOM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TAUNTON AVE
EAST PROVIDENCE RI
02914-1603
US

IV. Provider business mailing address

525 TAUNTON AVE
EAST PROVIDENCE RI
02914-1603
US

V. Phone/Fax

Practice location:
  • Phone: 401-438-3170
  • Fax: 401-438-3240
Mailing address:
  • Phone: 401-438-3170
  • Fax: 401-438-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberACF01543
License Number StateRI

VIII. Authorized Official

Name: JENNIFER MILLAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-438-3170