Basic Information
| Provider Information | |||||||||
| NPI: | 1386643294 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KENT COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 TOLL GATE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017377010 | ||||||||
| FaxNumber: | 4017361000 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 TOLL GATE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017377010 | ||||||||
| FaxNumber: | 4017361000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BURKE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4017377010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 282N00000X | HOS00125 | RI | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0000006109 | 01 | RI | KENT COUNTY PHYS VASC | OTHER | 0000006110 | 01 | RI | KENT COUNTY PHYS EEG | OTHER | 900247 | 01 | RI | KENT COUNTY MEMORIAL HOSP | OTHER | 4100009 | 05 | RI | MEDICAID | DD3248 | 01 | KENT COUNTY HOSPITAL | OTHER | 5000152 | 01 | RI | KENT COUNTY MEMORIAL HOSP | OTHER | 709006109 | 01 | RI | KENT COUNTY PHYS VASC | OTHER | 000000001935 | 01 | RI | KENT COUNTY MEMORIAL HOSP | OTHER | 0000006112 | 01 | RI | KENT COUNTY PHYS PULM | OTHER | 0000006181 | 01 | RI | KENT COUNTY PHYS PATH | OTHER | 0000000021 | 01 | RI | KENT COUNTY MEMORIAL HOSP | OTHER | 5000154 | 01 | RI | KENT COUNTY MEMORIAL HOSP | OTHER | OP00009 | 05 | RI | MEDICAID | 0000006111 | 01 | RI | KENT COUNTY PHYS EKG | OTHER |