Provider Demographics
NPI:1164540753
Name:DR. KENNETH J MORRISSEY, MD PC
Entity Type:Organization
Organization Name:DR. KENNETH J MORRISSEY, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-944-8700
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6068
Mailing Address - Country:US
Mailing Address - Phone:401-944-8700
Mailing Address - Fax:401-944-8767
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6068
Practice Address - Country:US
Practice Address - Phone:401-944-8700
Practice Address - Fax:401-944-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06505207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200054OtherBLUE CHIP
RI9002080Medicaid
RI9002080Medicaid
RI209002080Medicare PIN