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General NPI Number Information
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NPI Number | 1235554072
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Entity Type | Organization
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Legal Business Name | OCEAN STATE URGENT CARE CENTER OF WESTERLY, LLC
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 77 FRANKLIN STREET
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City | WESTERLY
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State | RI
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Zip | 02891
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Country | US
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Telephone | 401-596-6464
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Fax | 401-348-8660
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Provider Business Mailing Address
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Address Line | 77 FRANKLIN STREET
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City | WESTERLY
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State | RI
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Zip | 02891
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Country | US
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Telephone | 401-596-6464
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Fax | 401-348-8660
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MR. JONATHAN HAMILTON MARTIN
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Credential | MD
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Telephone | 401-596-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 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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