Healthcare Provider Details

I. General information

NPI: 1275725798
Provider Name (Legal Business Name): PREMIER ORTHOPEDICS & WORK REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 TEN ROD RD
NORTH KINGSTOWN RI
02852-4238
US

IV. Provider business mailing address

650 TEN ROD RD
NORTH KINGSTOWN RI
02852-4238
US

V. Phone/Fax

Practice location:
  • Phone: 401-667-7997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWN BAXTER
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 401-667-7997