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General NPI Number Information
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NPI Number | 1255418729
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Entity Type | Organization
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Legal Business Name | MEDICAL GROUP OF RHODE ISLAND,INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 37 WASHINGTON ST
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City | WEST WARWICK
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State | RI
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Zip | 02893-4927
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Country | US
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Telephone | 401-821-4707
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Fax | 401-821-8270
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Provider Business Mailing Address
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Address Line | 76 VERDANT DR
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City | CRANSTON
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State | RI
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Zip | 02920-1043
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Country | US
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Telephone | 401-828-5624
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. LUANN M KELLY
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Credential | NP
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Telephone | 401-467-6257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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