Provider Demographics
NPI:1093861858
Name:RADIATION ONCOLOGY SERVICES OF RHODE ISLAND, LLC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY SERVICES OF RHODE ISLAND, LLC
Other - Org Name:MADDOCK CENTER FOR RADIATION ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MBA
Authorized Official - Phone:401-732-2300
Mailing Address - Street 1:450 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2715
Mailing Address - Country:US
Mailing Address - Phone:401-732-2300
Mailing Address - Fax:401-738-3450
Practice Address - Street 1:450 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2715
Practice Address - Country:US
Practice Address - Phone:401-732-2300
Practice Address - Fax:401-738-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003644Medicaid
RI1750437448OtherGROUP NPI
RI709003644Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
RI709003644Medicare PIN