=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275565012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOVASCULAR ASSOCIATES OF RI, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 09/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1076 NORTH MAIN STREET
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-273-2460
-----------------------------------------------------
Fax | 401-273-2489
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1076 NORTH MAIN STREET
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-273-2460
-----------------------------------------------------
Fax | 401-273-2489
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL K HYDER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 401-273-2460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 12053
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------