Healthcare Provider Details

I. General information

NPI: 1043237621
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF KENT COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

IV. Provider business mailing address

PO BOX 419099
BOSTON MA
02241-9099
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-1516
  • Fax: 401-738-8837
Mailing address:
  • Phone: 401-738-1516
  • Fax: 401-738-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN COMITO
Title or Position: PRESIDENT
Credential: DO
Phone: 401-738-1516