Healthcare Provider Details

I. General information

NPI: 1831450865
Provider Name (Legal Business Name): ST JOSEPH HEALTH SERVICES OF RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH SERVICE AVE
NORTH PROVIDENCE RI
02904-5113
US

IV. Provider business mailing address

200 HIGH SERVICE AVE ADMINISTRATION OFFICE, ATTN: R. SOARES
NORTH PROVIDENCE RI
02904-5113
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-3000
  • Fax:
Mailing address:
  • Phone: 401-456-2525
  • Fax: 401-456-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberHOS00110
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberHOS00110
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberHOS00110
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberHO00110
License Number StateRI

VIII. Authorized Official

Name: MR. MICHAEL E CONKLIN JR.
Title or Position: SNR. VICE PRESIDENT, CFO
Credential:
Phone: 401-456-3000