Healthcare Provider Details

I. General information

NPI: 1316060171
Provider Name (Legal Business Name): THE MIRIAM HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8344
  • Fax: 401-444-7870
Mailing address:
  • Phone: 401-444-5640
  • Fax: 401-444-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License NumberHOS00122
License Number StateRI

VIII. Authorized Official

Name: MR. PETER K MARKELL
Title or Position: E VP & CFO
Credential:
Phone: 401-444-7914