Healthcare Provider Details

I. General information

NPI: 1720902141
Provider Name (Legal Business Name): BENJAMIN JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 TRENTON ST
PROVIDENCE RI
02906-3846
US

IV. Provider business mailing address

65 TRENTON ST
PROVIDENCE RI
02906-3846
US

V. Phone/Fax

Practice location:
  • Phone: 361-236-5663
  • Fax:
Mailing address:
  • Phone: 361-236-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP897608
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: