Provider Demographics
NPI: | 1063632180 |
---|---|
Name: | NEWPORT HOSPITAL |
Entity Type: | Organization |
Organization Name: | NEWPORT HOSPITAL |
Other - Org Name: | NEWPORT MULTISPECIALTY |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | EVP & CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PETER |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | MARKELL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 401-444-7914 |
Mailing Address - Street 1: | 117 ELLENFIELD ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PROVIDENCE |
Mailing Address - State: | RI |
Mailing Address - Zip Code: | 02905-4513 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 401-444-6905 |
Mailing Address - Fax: | 401-444-5462 |
Practice Address - Street 1: | 11 FRIENDSHIP ST |
Practice Address - Street 2: | |
Practice Address - City: | NEWPORT |
Practice Address - State: | RI |
Practice Address - Zip Code: | 02840-2209 |
Practice Address - Country: | US |
Practice Address - Phone: | 401-444-6905 |
Practice Address - Fax: | 401-444-6912 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | LIFESPAN CORPORATION |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-04-30 |
Last Update Date: | 2024-03-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
No | 207VX0000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | Group - Multi-Specialty |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 247ZC0005X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Clinical Laboratory Director, Non-physician | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
No | 363LP1700X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Perinatal | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
RI | 9006538 | Medicaid | |
RI | 229006544 | Medicare Oscar/Certification |