Healthcare Provider Details

I. General information

NPI: 1831521202
Provider Name (Legal Business Name): HEALTHCENTRIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PL SUITE 502
LINCOLN RI
02865-1179
US

IV. Provider business mailing address

6 BLACKSTONE VALLEY PL SUITE 502
LINCOLN RI
02865-1179
US

V. Phone/Fax

Practice location:
  • Phone: 401-334-6252
  • Fax: 401-334-6262
Mailing address:
  • Phone: 401-334-6252
  • Fax: 401-334-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPP33049
License Number StateRI

VIII. Authorized Official

Name: MR. HUGO M YAMADA
Title or Position: PHYSICIAN
Credential: MD
Phone: 401-334-6252