Healthcare Provider Details

I. General information

NPI: 1386863496
Provider Name (Legal Business Name): MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST
PAWTUCKET RI
02860-4400
US

IV. Provider business mailing address

111 BREWSTER ST
PAWTUCKET RI
02860-4400
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2000
  • Fax:
Mailing address:
  • Phone: 401-729-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCIS R DIETZ
Title or Position: CEO PRESIDENT
Credential:
Phone: 401-729-2000