Healthcare Provider Details

I. General information

NPI: 1619954724
Provider Name (Legal Business Name): LANDMARK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CASS AVE
WOONSOCKET RI
02895-4705
US

IV. Provider business mailing address

196 CASS AVE
WOONSOCKET RI
02895-4712
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-4100
  • Fax: 401-769-1744
Mailing address:
  • Phone: 401-769-4100
  • Fax: 401-765-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number00117
License Number StateRI

VIII. Authorized Official

Name: MARY MACINTOSH
Title or Position: SVP/CFO
Credential:
Phone: 401-769-4100