Healthcare Provider Details

I. General information

NPI: 1881647238
Provider Name (Legal Business Name): NORTHWESTERN RI IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

800 W CUMMINGS PARK SUITE 1350
WOBURN MA
01801-6372
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-0900
  • Fax: 401-455-0909
Mailing address:
  • Phone: 781-569-6541
  • Fax: 781-569-6557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberACF01564
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A SANTAMARIA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 781-569-6541