Healthcare Provider Details

I. General information

NPI: 1689657249
Provider Name (Legal Business Name): IMAGING NETWORK OF RHODE ISLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE ROGERS WILLIAMS MEDICAL CENTER
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

PO BOX 9132
BROOKLINE MA
02446-9132
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2204
  • Fax:
Mailing address:
  • Phone: 603-893-9784
  • Fax: 603-893-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN STAINKEN
Title or Position: DELEGATE
Credential: M.D.
Phone: 401-334-2423