MEDICARE: NORTHWESTERN RI IMAGING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	ACF01564	RI
3	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881647238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWESTERN RI IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	800 W CUMMINGS PARK
Second Line	:	SUITE 1350
City	:	WOBURN
State	:	MA
Zip	:	01801-6372
Country	:	US
Telephone Number	:	781-569-6541
Fax Number	:	781-569-6557

Provider Business Practice Location Address
First Line	:	1526 ATWOOD AVE
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-3289
Country	:	US
Telephone Number	:	401-331-0900
Fax Number	:	401-455-0909

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	ROBERT A SANTAMARIA
Credential	:
Telephone Number	:	781-569-6541

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/31/2008

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