Healthcare Provider Details

I. General information

NPI: 1003284506
Provider Name (Legal Business Name): OCEAN STATE URGENT CARE AT ST JOSEPH HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PEACE ST
PROVIDENCE RI
02907-1510
US

IV. Provider business mailing address

2130 MENDON RD SUITE 3-333
CUMBERLAND RI
02864-3844
US

V. Phone/Fax

Practice location:
  • Phone: 301-314-3999
  • Fax: 401-808-6294
Mailing address:
  • Phone: 401-235-7310
  • Fax: 401-235-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANK D'ALESSANDRO
Title or Position: PARTNER
Credential: MD
Phone: 40133399595