Healthcare Provider Details

I. General information

NPI: 1356478002
Provider Name (Legal Business Name): ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date: 09/19/2007
Reactivation Date: 04/24/2012

III. Provider practice location address

21 PEACE ST
PROVIDENCE RI
02907-1510
US

IV. Provider business mailing address

200 HIGH SERVICE AVE
NORTH PROVIDENCE RI
02904-5113
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-4380
  • Fax: 401-456-4428
Mailing address:
  • Phone: 401-456-2525
  • Fax: 401-456-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberHOS00100
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHS00100
License Number StateRI

VIII. Authorized Official

Name: KENNETH H BELCHER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 401-456-2525