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General NPI Number Information
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NPI Number | 1558531467
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Entity Type | Organization
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Legal Business Name | EAST SIDE URGENT CARE LLC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 1195 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-1824
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Country | US
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Telephone | 401-861-3782
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-1824
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Country | US
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Telephone | 401-861-3782
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Fax |
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | JULIE ELIZABETH HETRICK
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Credential | R.N.
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Telephone | 401-578-8836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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