Provider Demographics
NPI:1487649430
Name:THE MIRIAM HOSPITAL
Entity Type:Organization
Organization Name:THE MIRIAM HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:E VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-444-7914
Mailing Address - Street 1:117 ELLENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-5640
Mailing Address - Fax:401-444-5862
Practice Address - Street 1:164 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2853
Practice Address - Country:US
Practice Address - Phone:401-444-6966
Practice Address - Fax:401-444-5462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPAN CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-15
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI122282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1937OtherNHPRI HOSPITAL PROV ID
RI900949OtherTUFTS OP PROVIDER ID
RIRI0017OtherHEALTHNET NORTH EAST PROV
RIH00108OtherBLUE CHIP RI PROVIDER ID
RI4100012Medicaid
RI900197OtherHARVARD HLTH PROVIDER ID
RI994559OtherCONNECTICARE
RIA0290600OtherJOHN DEERE PROV ID
RI1512083OtherGATEWAY HLTH PROVIDER ID
RI5000417OtherUHCNE HOSPITAL PROV ID
RI802308OtherMVP PROVIDER ID
RI0008269OtherNHPMA HOSPITAL PROV ID
RIOP00012Medicaid
RI0000000004OtherBCBSRI HOSPITAL PROV ID
RI000000022028OtherBOSTON MED CTR PROV ID
RI0007373OtherAETNA HOSPITAL PROV ID
RI904801OtherTUFTS INPT PROVIDER ID
RI900197OtherHARVARD HLTH PROVIDER ID
RIOP00012Medicaid