Provider Demographics
NPI:1457459943
Name:KENT SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KENT SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ST.JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-737-4828
Mailing Address - Street 1:227 CENTERVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4394
Mailing Address - Country:US
Mailing Address - Phone:401-737-4828
Mailing Address - Fax:401-732-8484
Practice Address - Street 1:227 CENTERVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4394
Practice Address - Country:US
Practice Address - Phone:401-737-4828
Practice Address - Fax:401-732-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKS00507Medicaid
RI838-7OtherRI BLUE SHIELD
RI029000838Medicare ID - Type Unspecified