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General NPI Number Information
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NPI Number | 1205364544
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Entity Type | Organization
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Legal Business Name | OCEAN STATE URGENT CARE CENTER OF NORTH PROVIDENCE, LLC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 1637 MINERAL SPRING AVE STE 115
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4042
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Country | US
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Telephone | 401-353-1012
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Fax | 401-353-6362
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Provider Business Mailing Address
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Address Line | 2130 MENDON RD STE 3-333
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City | CUMBERLAND
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State | RI
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Zip | 02864-3844
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | JEN ZUBA
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Credential |
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Telephone | 401-235-7310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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