Healthcare Provider Details

I. General information

NPI: 1992840862
Provider Name (Legal Business Name): ST. JOSEPH HEALTH SERVICES OF RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date: 09/19/2007
Reactivation Date: 12/22/2009

III. Provider practice location address

200 HIGH SERVICE AVE
NORTH PROVIDENCE RI
02904-5113
US

IV. Provider business mailing address

200 HIGH SERVICE AVE 4TH FL. MARION HALL
NORTH PROVIDENCE RI
02904-5113
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-3309
  • Fax: 401-456-3762
Mailing address:
  • Phone: 401-456-3309
  • Fax: 401-456-3762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHOS00110
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberHOS00110
License Number StateRI

VIII. Authorized Official

Name: JOHN FOGARTY
Title or Position: PRESIDENT
Credential: CEO
Phone: 401-456-3309