Provider Demographics
NPI:1073973574
Name:OCEAN STATE URGENT CARE CENTER OF WOONSOCKET
Entity Type:Organization
Organization Name:OCEAN STATE URGENT CARE CENTER OF WOONSOCKET
Other - Org Name:OCEAN STATE PRIMARY CARE OF WOONSOCKET
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-235-7310
Mailing Address - Street 1:25 JOHN A CUMMINGS WAY
Mailing Address - Street 2:3RD FLOOR; SUITE 301
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3244
Mailing Address - Country:US
Mailing Address - Phone:401-235-7310
Mailing Address - Fax:401-235-7314
Practice Address - Street 1:25 JOHN A CUMMINGS WAY
Practice Address - Street 2:3RD FLOOR; SUITE 301
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3244
Practice Address - Country:US
Practice Address - Phone:401-235-7310
Practice Address - Fax:401-235-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty