Healthcare Provider Details

I. General information

NPI: 1215974365
Provider Name (Legal Business Name): ROGER WILLIAMS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2677
  • Fax: 401-456-6742
Mailing address:
  • Phone: 401-456-2525
  • Fax: 401-456-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KENNETH BELCHER
Title or Position: A/R ANALYST
Credential:
Phone: 401-456-2000