Provider Demographics
NPI:1225184617
Name:ST. JOSEPH HEALTH SERVICES OF RI,
Entity Type:Organization
Organization Name:ST. JOSEPH HEALTH SERVICES OF RI,
Other - Org Name:ST. JOSEPH HOSP. FOR SPECIALTY CARE-PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIMIG
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:401-456-3000
Mailing Address - Street 1:200 HIGH SERVICE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5113
Mailing Address - Country:US
Mailing Address - Phone:401-456-3000
Mailing Address - Fax:401-456-3762
Practice Address - Street 1:21 PEACE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1510
Practice Address - Country:US
Practice Address - Phone:401-456-4300
Practice Address - Fax:401-456-4050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPHS HEALTH SERVICES OF RI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2014-02-14
Deactivation Date:2007-09-19
Deactivation Code:
Reactivation Date:2014-02-14
Provider Licenses
StateLicense IDTaxonomies
RIHOS00110282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI379025312Medicare ID - Type Unspecified