Provider Demographics
NPI:1215358916
Name:PRIME HEALTHCARE SERVICES-LANDMARK,LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES-LANDMARK,LLC
Other - Org Name:RHRI EKG DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-769-4100
Mailing Address - Street 1:196 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4712
Mailing Address - Country:US
Mailing Address - Phone:401-769-4011
Mailing Address - Fax:401-765-6024
Practice Address - Street 1:116 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7327
Practice Address - Country:US
Practice Address - Phone:401-769-4011
Practice Address - Fax:401-765-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRH05229Medicaid
RI069006786Medicare Oscar/Certification