=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104934652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDOCRINE TREATMENT CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 12/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 WAKE ROBIN RD SUITE 207
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02865-4295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-334-2242
-----------------------------------------------------
Fax | 401-334-0376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 WAKE ROBIN RD SUITE 207
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02865-4295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-334-2242
-----------------------------------------------------
Fax | 401-334-0376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | DR. MICHAEL DAVID HEIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 401-334-2242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD07593
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------