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General NPI Number Information
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NPI Number | 1851374508
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Entity Type | Organization
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Legal Business Name | LAKE MISHNOCK VOLUNTEER FIRE
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 166 MISHNOCK RD
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City | W GREENWICH
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State | RI
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Zip | 02817-1669
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Country | US
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Telephone | 401-397-7353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20104
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City | CRANSTON
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State | RI
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Zip | 02920-0927
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Country | US
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Telephone | 401-572-3120
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Fax | 401-572-3351
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Authorized Official
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Title or Position | CAPTAIN
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Name | JAMES R GALLIGAN JR.
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Credential |
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Telephone | 401-397-7353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 50
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License Number State | RI
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