Provider Demographics
NPI:1073539227
Name:MEDICINE AND LONG TERM CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MEDICINE AND LONG TERM CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAO
Authorized Official - Middle Name:YUAN
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-943-4530
Mailing Address - Street 1:333 BUDLONG RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6337
Mailing Address - Country:US
Mailing Address - Phone:401-943-4530
Mailing Address - Fax:
Practice Address - Street 1:333 BUDLONG RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6337
Practice Address - Country:US
Practice Address - Phone:401-943-4530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6040207R00000X
RI12044207R00000X
RIMD03601207R00000X
RI12101207RI0200X
RIPA00420363A00000X
RIPA00144363A00000X
RI00220363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004948Medicaid