Healthcare Provider Details

I. General information

NPI: 1164472718
Provider Name (Legal Business Name): KENT EMERGENCY PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/04/2010
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

15 CENTER ST
FAIRHAVEN MA
02719-2928
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7000
  • Fax: 401-736-1009
Mailing address:
  • Phone: 508-984-1410
  • Fax: 508-979-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDY REIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 508-984-1410