Healthcare Provider Details

I. General information

NPI: 1992757017
Provider Name (Legal Business Name): NORTH PROVIDENCE MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 MINERAL SPRING AVE SUITE 115
NORTH PROVIDENCE RI
02904-4042
US

IV. Provider business mailing address

1637 MINERAL SPRING AVE SUITE 115
NORTH PROVIDENCE RI
02904-4042
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-1012
  • Fax: 401-353-6362
Mailing address:
  • Phone: 401-353-1012
  • Fax: 401-353-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberMD10188
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD05562
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberMD05562
License Number StateRI

VIII. Authorized Official

Name: MR. STEPHEN D'AMATO
Title or Position: OWNER
Credential: M.D.
Phone: 401-353-1012