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General NPI Number Information
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NPI Number | 1508279274
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Entity Type | Organization
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Legal Business Name | INPATIENT MEDICAL ASSOCIATES OF PROVIDENCE LLC
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 200 HIGH SERVICE AVE OUR LADY OF FATIMA HOSPITAL
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-5113
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Country | US
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Telephone | 469-401-2386
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Fax |
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD STE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1374
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Country | US
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Telephone | 469-401-2386
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY BYRNE
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Credential | MD
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Telephone | 469-401-2386
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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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