Basic Information
| Provider Information | |||||||||
| NPI: | 1063402964 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS OF RHODE ISLAND MEDICAL ENTERPRISES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27 | ||||||||
| Address2: | |||||||||
| City: | MANVILLE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028380027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009270002 | ||||||||
| FaxNumber: | 6038901236 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 NATE WHIPPLE HWY | ||||||||
| Address2: | SUITE 101 CUMBERLAND MEDICAL CENTER | ||||||||
| City: | CUMBERLAND | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028641403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016582020 | ||||||||
| FaxNumber: | 4016583612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 02/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4016582020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | PR32677 | 05 | RI | MEDICAID | 685836 | 01 | MA | TUFTS | OTHER |