Healthcare Provider Details

I. General information

NPI: 1235348335
Provider Name (Legal Business Name): EAST BAY ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CLOCK TOWER SQUARE
PORTSMOUTH RI
02871
US

IV. Provider business mailing address

33 STANIFORD ST
PROVIDENCE RI
02905-3105
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-8800
  • Fax: 401-278-4070
Mailing address:
  • Phone: 401-421-8800
  • Fax: 401-278-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954