Healthcare Provider Details

I. General information

NPI: 1053038471
Provider Name (Legal Business Name): AFFINITY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST DEPT OF
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

455 TOLL GATE RD CREDENTIALING-ANESTHESIOLOGY
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1122
  • Fax:
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DAWN LYNN RODGERS
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 401-659-5589