Basic Information
| Provider Information | |||||||||
| NPI: | 1588659528 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RHODE ISLAND HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 ELLENFIELD ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029054513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014446779 | ||||||||
| FaxNumber: | 4014446912 | ||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014446966 | ||||||||
| FaxNumber: | 4014445462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | KIRSHNER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4014447914 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LIFESPAN CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | HOS00121 | RI | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 07278 | 01 | RI | GHI HMO PROVIDER ID | OTHER | 5000801 | 01 | RI | UHCNE HOSPITAL PROV ID | OTHER | A0290301 | 01 | RI | JOHN DEERE HLTH PROV ID | OTHER | 0000000006 | 01 | RI | BCBSRI HOSPITAL PROV ID | OTHER | 4100007 | 05 | RI | MEDICAID | 0007428 | 01 | RI | NHPMA HOSPITAL PROV ID | OTHER | 0696 | 01 | RI | MVP PROVIDER ID | OTHER | 1509503 | 01 | RI | GATEWAY HLTH PROVIDER ID | OTHER | 900105 | 01 | RI | TUFTS OP PROVIDER ID | OTHER | H00101 | 01 | RI | BCHIP HOSPITAL PROV ID | OTHER | 000000022148 | 01 | RI | BOSTON MEDICAL PROV ID | OTHER | 990626 | 01 | RI | CONNECTICARE PROV ID | OTHER | OP00007 | 05 | RI | MEDICAID | 0009790 | 01 | RI | AETNA PROVIDER ID | OTHER | 1931 | 01 | RI | NHPRI HOSPITAL PROV ID | OTHER | 904803 | 01 | RI | TUFTS IP PROVIDER ID | OTHER |