Provider Demographics
NPI:1174690887
Name:STATE OF RHODE ISLAND
Entity Type:Organization
Organization Name:STATE OF RHODE ISLAND
Other - Org Name:RHODE ISLAND STATE HEALTH LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-222-1720
Mailing Address - Street 1:50 ORMS ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2222
Mailing Address - Country:US
Mailing Address - Phone:401-222-5600
Mailing Address - Fax:401-222-6985
Practice Address - Street 1:50 ORMS ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2222
Practice Address - Country:US
Practice Address - Phone:401-222-5600
Practice Address - Fax:401-222-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCI00216291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory