Provider Demographics
NPI:1629168901
Name:RI DEPARTMENF OF CORRECTIONS
Entity Type:Organization
Organization Name:RI DEPARTMENF OF CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:POSHKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-462-1115
Mailing Address - Street 1:147 SEASCAPE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5852
Mailing Address - Country:US
Mailing Address - Phone:401-846-9628
Mailing Address - Fax:
Practice Address - Street 1:39 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3001
Practice Address - Country:US
Practice Address - Phone:401-462-2268
Practice Address - Fax:401-462-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00221363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty