Healthcare Provider Details

I. General information

NPI: 1295105294
Provider Name (Legal Business Name): SILVER SPRING HEALTH CARE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KENYON AVE
WAKEFIELD RI
02879-4216
US

IV. Provider business mailing address

PO BOX 229
WAKEFIELD RI
02880-0229
US

V. Phone/Fax

Practice location:
  • Phone: 401-788-1127
  • Fax:
Mailing address:
  • Phone: 401-788-8757
  • Fax: 401-782-9867

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 Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCIA T POLHEMUS
Title or Position: CONTROLLER
Credential:
Phone: 401-788-1974