Healthcare Provider Details

I. General information

NPI: 1437232543
Provider Name (Legal Business Name): PROVIDENCE SURGICAL CARE GROUP, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 SILVER SPRING ST
PROVIDENCE RI
02904-1556
US

IV. Provider business mailing address

486 SILVER SPRING ST
PROVIDENCE RI
02904-1556
US

V. Phone/Fax

Practice location:
  • Phone: 401-454-0690
  • Fax: 401-454-4281
Mailing address:
  • Phone: 401-454-0690
  • Fax: 401-454-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT B PATTERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 401-454-0690