Provider Demographics
NPI:1295818078
Name:EAST PROVIDENCE EMERGENCY ROOM INC
Entity Type:Organization
Organization Name:EAST PROVIDENCE EMERGENCY ROOM INC
Other - Org Name:EAST PROVIDENCE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-438-3170
Mailing Address - Street 1:525 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1603
Mailing Address - Country:US
Mailing Address - Phone:401-438-3170
Mailing Address - Fax:401-438-3240
Practice Address - Street 1:525 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1603
Practice Address - Country:US
Practice Address - Phone:401-438-3170
Practice Address - Fax:401-438-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIACF01543261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0458460001Medicare NSC